Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 1/2012

01-05-2012 | Review

Ultrasonographic differentiation of malignant from benign breast lesions: a meta-analytic comparison of elasticity and BIRADS scoring

Authors: Gelareh Sadigh, Ruth C. Carlos, Colleen H. Neal, Ben A. Dwamena

Published in: Breast Cancer Research and Treatment | Issue 1/2012

Login to get access

Abstract

There has been controversy regarding the accuracy of breast ultrasound elastography (USE) compared to conventional B-mode Ultrasound (USB). The purpose of this study was to conduct a direct comparative effectiveness analysis of USB versus USE or their combination in differentiating breast lesions through systematically reviewing recent literature. An extensive literature search of PubMed and other medical and general purpose databases from inception through August 2011 was conducted. Published studies that reported a direct comparison of the diagnostic performance of USE, using elasticity score versus USB, using breast imaging reporting and data system (BIRADS) for characterization of focal breast lesions were included. Summary diagnostic performance measures were assessed for each of the tests and their combination using bivariate generalized linear mixed modeling. The two tests were combined as: (1) conjunctive, where the outcome of the combination of tests is positive only if both test results are positive; (2) disjunctive, where the outcome of a combination of tests is negative only if both tests are negative. Twenty nine studies provided relevant information on 5,511 breast masses (2,065 cancers, 3,446 benign lesions). Sensitivity of USB, USE, and their conjunctive and disjunctive combinations were 96% (95% credible interval (CrI), 93–98%), 79% (95% CrI, 74–83%), 73% (95% CrI, 67–78%), and 99% (95% CrI, 98–99%), respectively. Specificity of USB, USE, and their conjunctive and disjunctive combinations were 70% (95% CrI, 55–83%), 88% (95% CrI, 82–92%), 97% (95% CrI, 95–99%), and 56% (95% CrI, 43–69%), respectively. The application of USE as a single test is not superior to USB alone. However, in low risk patients it is recommended to perform an USE following a positive USB result to decrease the rate of unnecessary biopsies.
Appendix
Available only for authorised users
Literature
1.
Garra BS (2007) Imaging and estimation of tissue elasticity by ultrasound. Ultrasound Q 23:255–268PubMedCrossRef
2.
Hatzung G, Grunwald S, Zygmunt M et al (2010) Sonoelastography in the Diagnosis of Malignant and Benign Breast Lesions: Initial Clinical Experiences. Ultraschall Med 31:596–603PubMedCrossRef
3.
Itoh A, Ueno E, Tohno E et al (2006) Breast disease: clinical application of US elastography for diagnosis. Radiology 239:341–350PubMedCrossRef
4.
Wells PN, Liang HD (2011) Medical ultrasound: imaging of soft tissue strain and elasticity. J R Soc Interface. [Epub ahead of print]
5.
Regini E, Bagnera S, Tota D et al (2010) Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions. Radiol Med 115:551–562PubMedCrossRef
6.
Chang JM, Moon WK, Cho N, Kim SJ (2011) Breast mass evaluation: factors influencing the quality of US elastography. Radiology 259:59–64PubMedCrossRef
7.
Navarro B, Ubeda B, Vallespi M et al (2011) Role of elastography in the assessment of breast lesions: preliminary results. J Ultrasound Med 30:313–321PubMed
8.
Lee JH, Kim SH, Kang BJ et al (2011) Role and clinical usefulness of elastography in small breast masses. Acad Radiol 18:74–80PubMedCrossRef
9.
Fischer T, Peisker U, Fiedor S et al. (2011) Significant Differentiation of Focal Breast Lesions: Raw Data-Based Calculation of Strain Ratio. Ultraschall Med. [Epub ahead of print]
10.
Yerli H, Yilmaz T, Kaskati T, Gulay H (2011) Qualitative and semiquantitative evaluations of solid breast lesions by sonoelastography. J Ultrasound Med 30:179–186PubMed
11.
Kumm TR, Szabunio MM (2010) Elastography for the characterization of breast lesions: initial clinical experience. Cancer Control 17:156–161PubMed
12.
Thomas A, Degenhardt F, Farrokh A et al (2010) Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography. Acad Radiol 17:558–563PubMedCrossRef
13.
Thomas A, Fischer T, Frey H et al (2006) Real-time elastography–an advanced method of ultrasound: First results in 108 patients with breast lesions. Ultrasound Obstet Gynecol 28:335–340PubMedCrossRef
14.
Thomas A, Kummel S, Fritzsche F et al (2006) Real-time sonoelastography performed in addition to B-mode ultrasound and mammography: improved differentiation of breast lesions? Acad Radiol 13:1496–1504PubMedCrossRef
15.
Thomas A, Warm M, Hoopmann M et al (2007) Tissue Doppler and strain imaging for evaluating tissue elasticity of breast lesions. Acad Radiol 14:522–529PubMedCrossRef
16.
Wojcinski S, Farrokh A, Weber S et al (2010) Multicenter Study of Ultrasound Real-Time Tissue Elastography in 779 Cases for the Assessment of Breast Lesions: Improved Diagnostic Performance by Combining the BI-RADS(R)-US Classification System with Sonoelastography. Ultraschall Med 31:484–491PubMedCrossRef
17.
Parajuly SS, Lan PY, Yan L et al (2010) Breast elastography: a hospital-based preliminary study in China. Asian Pac J Cancer Prev 11:809–814PubMed
18.
Ciurea AI, Bolboaca SD, Ciortea CA et al (2011) The influence of technical factors on sonoelastographic assessment of solid breast nodules. Ultraschall Med 32(Suppl 1):S27–S34PubMedCrossRef
19.
Chung SY, Moon WK, Choi JW et al (2010) Differentiation of benign from malignant nonpalpable breast masses: a comparison of computer-assisted quantification and visual assessment of lesion stiffness with the use of sonographic elastography. Acta Radiol 51:9–14PubMedCrossRef
20.
Raza S, Odulate A, Ong EM et al (2010) Using real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med 29:551–563PubMed
21.
Zhi H, Xiao XY, Yang HY et al (2010) Ultrasonic elastography in breast cancer diagnosis: strain ratio vs. 5-point scale. Acad Radiol 17:1227–1233PubMedCrossRef
22.
Sohn YM, Kim MJ, Kim EK et al (2009) Sonographic elastography combined with conventional sonography: how much is it helpful for diagnostic performance? J Ultrasound Med 28:413–420PubMed
23.
Schaefer FK, Heer I, Schaefer PJ et al (2009) Breast ultrasound elastography—Results of 193 breast lesions in a prospective study with histopathologic correlation. Eur J Radiol 77:450–456PubMedCrossRef
24.
Zhu QL, Jiang YX, Liu JB et al (2008) Real-time ultrasound elastography: its potential role in assessment of breast lesions. Ultrasound Med Biol 34:1232–1238PubMedCrossRef
25.
Vanhoutte A, Fellah L, Galant C et al (2008) Contribution of sonoelastography to the characterization of breast lesions. JBR-BTR 91:187–194PubMed
26.
Tan SM, Teh HS, Mancer JF, Poh WT (2008) Improving B mode ultrasound evaluation of breast lesions with real-time ultrasound elastography—a clinical approach. Breast 17:252–257PubMedCrossRef
27.
Zhi H, Ou B, Luo BM et al (2007) Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions. J Ultrasound Med 26:807–815PubMed
28.
Scaperrotta G, Ferranti C, Costa C et al (2008) Role of sonoelastography in non-palpable breast lesions. Eur Radiol 18:2381–2389PubMedCrossRef
29.
Cho N, Moon WK, Park JS et al (2008) Nonpalpable breast masses: evaluation by US elastography. Korean J Radiol 9:111–118PubMedCrossRef
30.
Satake H, Nishio A, Ikeda M et al (2011) Predictive value for malignancy of suspicious breast masses of BI-RADS categories 4 and 5 using ultrasound elastography and MR diffusion-weighted imaging. AJR Am J Roentgenol 196:202–209PubMedCrossRef
31.
Tardivon A, El Khoury C, Thibault F et al (2007) Elastography of the breast: a prospective study of 122 lesions. J Radiol 88:657–662PubMedCrossRef
32.
Giuseppetti GM, Martegani A, Di Cioccio B, Baldassarre S (2005) Elastosonography in the diagnosis of the nodular breast lesions: preliminary report. Radiol Med 110:69–76PubMed
33.
Kadour MJ, Adams R, English R et al (2010) Slip imaging: reducing ambiguity in breast lesion assessment. Ultrasound Med Biol 36:2027–2035PubMedCrossRef
34.
Bartolotta TV, Ienzi R, Cirino A et al (2011) Characterisation of indeterminate focal breast lesions on grey-scale ultrasound: role of ultrasound elastography. Radiol Med 116:1027–1038
35.
Zhuang C, Xiao Y (2009) Ultrasonic elastography and molybdenum X-ray photography in differential diagnosis of breast diseases. Zhong Nan Da Xue Xue Bao Yi Xue Ban 34:67–71PubMed
36.
Zhang XF, Liu XM, Bao XF et al (2006) Application of real-time tissue elastography in diagnosis of breast cancer. Zhejiang Da Xue Xue Bao Yi Xue Ban 35:444–447PubMed
37.
Gong X, Xu Q, Xu Z et al (2011) Real-time elastography for the differentiation of benign and malignant breast lesions: a meta-analysis. Breast Cancer Res Treat 130:11–18
38.
Sadigh G, Carlos RC, Neal CH, Dwamena BA (2011) Accuracy of ultrasound elastography for differentiation of malignant and benign breast abnormalities: a meta-analysis. Radiology (Accepted for publication)
39.
Tohno E, Ueno E (2008) Current improvements in breast ultrasound, with a special focus on elastography. Breast Cancer 15:200–204PubMedCrossRef
40.
Yoon JH, Kim MH, Kim EK et al (2011) Interobserver variability of ultrasound elastography: how it affects the diagnosis of breast lesions. AJR Am J Roentgenol 196:730–736PubMedCrossRef
41.
42.
Ament A, Hasman A (1993) Optimal test strategy in the case of two tests and one disease. Int J Biomed Comput 33:179–197PubMedCrossRef
43.
44.
Whiting P, Rutjes AW, Reitsma JB et al (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCrossRef
45.
Chu H, Cole SR (2006) Bivariate meta-analysis of sensitivity and specificity with sparse data: a generalized linear mixed model approach. J Clin Epidemiol 59:1331–1332 (author reply 1332–1333)PubMedCrossRef
46.
Arends LR, Hamza TH, van Houwelingen JC et al (2008) Bivariate random effects meta-analysis of ROC curves. Med Decis Mak 28:621–638CrossRef
47.
Cronin P, Dwamena BA, Kelly AM et al (2008) Solitary pulmonary nodules and masses: a meta-analysis of the diagnostic utility of alternative imaging tests. Eur Radiol 18:1840–1856PubMedCrossRef
48.
Chappell FM, Raab GM, Wardlaw JM (2009) When are summary ROC curves appropriate for diagnostic meta-analyses? Stat Med 28:2653–2668PubMedCrossRef
49.
Deeks JJ, Macaskill P, Irwig L (2005) The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol 58:882–893PubMedCrossRef
50.
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560PubMedCrossRef
51.
52.
Fleury Ede F, Fleury JC, Oliveira VM et al (2009) Proposal for the systematization of the elastographic study of mammary lesions through ultrasound scan. Rev Assoc Med Bras 55:192–196PubMedCrossRef
53.
Fleury Ede F, Fleury JC, Piato S, Roveda D Jr (2009) New elastographic classification of breast lesions during and after compression. Diagn Interv Radiol 15:96–103PubMed
54.
Wang Z, Yang T, Wu Z et al (2010) Correlation between elastography score and strain rate ratio in breast small tumor. Zhong Nan Da Xue Xue Bao Yi Xue Ban 35:928–932PubMed
55.
Jones CM, Athanasiou T (2009) Diagnostic accuracy meta-analysis: review of an important tool in radiological research and decision making. Br J Radiol 82:441–446PubMedCrossRef
56.
57.
Moon HJ, Kim MJ, Kwak JY, Kim EK (2010) Probably benign breast lesions on ultrasonography: a retrospective review of ultrasonographic features and clinical factors affecting the BI-RADS categorization. Acta Radiol 51:375–382PubMedCrossRef
58.
Gutwein LG, Ang DN, Liu H et al (2011) Utilization of minimally invasive breast biopsy for the evaluation of suspicious breast lesions. Am J Surg 202:127–132
59.
Bennett ML, Welman CJ, Celliers LM (2011) How reassuring is a normal breast ultrasound in assessment of a screen-detected mammographic abnormality? A review of interval cancers after assessment that included ultrasound evaluation. Clin Radiol 66:928–939
Metadata
Title
Ultrasonographic differentiation of malignant from benign breast lesions: a meta-analytic comparison of elasticity and BIRADS scoring
Authors
Gelareh Sadigh
Ruth C. Carlos
Colleen H. Neal
Ben A. Dwamena
Publication date
01-05-2012
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 1/2012
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-011-1857-8

Other articles of this Issue 1/2012

Breast Cancer Research and Treatment 1/2012 Go to the issue

Preclinical Study

Histologic findings in normal breast tissues: comparison to reduction mammaplasty and benign breast disease tissues

Brief Report

Evaluation of RAD51C as cancer susceptibility gene in a large breast-ovarian cancer patient population referred for genetic testing

Epidemiology

Structural/organizational characteristics of health services partly explain racial variation in timeliness of radiation therapy among elderly breast cancer patients

Preclinical study

Role of Src in breast cancer cell migration and invasion in a breast cell/bone-derived cell microenvironment

Clinical trial

Dose-dependent change in biomarkers during neoadjuvant endocrine therapy with fulvestrant: results from NEWEST, a randomized Phase II study

Epidemiology

Adherence and discontinuation of adjuvant hormonal therapy in breast cancer patients: a population-based study
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits