Comparison of conventional B mode ultrasound with elastography for differentiation of benign and malignant breast mass
- Author Dinesh Maharjan
- DOI http://wwj
- Country : Nepal
- Subject : Health Sciences
Keywords : breast, benign, elastography, malignant, nodule, ultrasonography
Abstract
Introduction: Breast cancer is the most common cancer in female worldwide. Imaging plays important role in early diagnosis of breast cancer. Deaths due to breast cancer are decreasing in developed countries due to early detection and treatment. Although mammography is modality of choice for screening breast cancer, in developing countries ultrasonography is commonly used for evaluation of breast disease. Conventional B mode ultrasound has good sensitivity and specificity in differentiating the benign and malignant breast lesion. However there has been significant increase in number of fine needle aspiration or biopsy even for benign nodule when only B mode evaluation was used for evaluation of lesion. Elastography is newer development in ultrasonography which can detect the hardness of lesion qualitatively and quantitatively. Elastography findings can be used in differentiating benign breast lesion from malignant lesion.
Methodology: This was a prospective crossectional study done in 54 patients with sonographically proven solid breast lesion. Conventional B-mode sonography was performed and lesions were characterized as benign and malignant depending upon various characteristics of lesion. Following that elastography was performed and lesions were evaluated with elastography 5-point score and strain ratio of lesions measured. Lesions were then evaluated pathologically. Sample for pathological examination was obtained by ultrasound guided FNAC or core biopsy. Conventional sonographic findings and elastography findings were correlated with pathological diagnosis and accuracy of conventional sonography and elastography for differentiating benign and malignant breast lesions were assessed and compared.
Results: Out of 54 breast lesions 31 lesions were benign and 23 were malignant. Conventional Sonography showed sensitivity, specificity and accuracy of 86.9%, 87.1%, and 87.0% respectively, in differentiating benign and malignant breast lesion. Elastography 5-point score system showed better sensitivity specificity and accuracy than conventional Sonography (95.6%, 96.7%, and 96.2% respectively). Strain ratio measurement of lesions showed when cut off value of 3.9 was used, sensitivity and specificity were 96.8% and 91.3%. ROC curve analysis showed area under curve for conventional sonography, elastography 5-point score system and strain ratio measurements were 0.870 ± 0.054, 0.962±0.031 and 0.969 ±0.026 respectively.
Conclusion: Elastography provides more precise differentiation between malignant breast lesions from benign breast lesions. No significant differences were noted between Elastographic 5 point score system and strain ratio measurements in differentiating benign and malignant breast lesions.
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