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Ultrasound strain Elastography of Normal Breast Tissue in Correlation with Mammographic Breast Density

Authors: Wasan Ismail Al-Saadi --- Suha Hussain Hayyawi --- Noor Kadhum Neema --- Huda Fawzi Salih
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 3 Pages: 45-51
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Strain elastography is relatively new ultrasound technique that assess elasticity of the tissue .This technique utilize the relative strain of the tissue of interest to generate color coded image and to measure the strain ratio. It has been extensively investigated and introduced as a promising technique for characterization of breast masses. Aim of study:To assess the relative strain of fat and glandular tissue as well as the strain ratio in relation to different mammographic breast density categories and with respect to the depth of tissue Subjects and Methods: A total of 162 women with normal breast imaging were included and categorized according to the American College of Radiologists (ACR) mammographic breast density categories (A, B , C , D). Elastography examination was performed for a single normal breast and the relative strain of the fatty tissue and glandular tissue at most superficial location as well as at 1-2 cm in depth were recorded . In addition the fat:glandular strain ratio was estimated. The elastographic variables were assessed with each other and with respect to breast density & the tissue depth Results:The subjects were subdivided according to ACR density system. It has been found that the mean relative strain of fat was higher in category A (0.30) in comparison with the other categories with statistically significant difference , however the relative strain of the glandular tissue was rather comparable between category A (0.25), category B (0.24) and category C (0.22) with statistically significant difference with category D(0.20) .The strain ratio was significantly different in category B (1.10) and category C (1.05) in comparison with category A (1.22).Comparing the relative strain in different depth revealed rather similar results where relative strain of fat in ( 1- 2 cm ) below Ref show significant difference in category B(0.21) and category C(0.20) in comparison with category A (0.29) as category group D is extremely dense so no fat tissue below ROI could be measured. Similarly the relative strain of glandular tissue in 1-2 cm below ROI show significant difference between category A (0.23) and category B (0.22) with category C and D (0.19 for both). Conclusion:The fat tissue elasticity is rather different in different breast density categories with higher elasticity of the fat in category A breast density (fatty breasts) as compared to other breast density categories .The glandular tissue strain is rather more comparable in the breasts in category B, C, and D and thus it may more convenient to use the glandular tissue as a reference tissue when assessing the relative elasticity of breast masses. Moreover , the depth of the measurement of the tissue elasticity has a significant influence on the quantitative assessment of the elastographic image


Article
Ultrasound and Strain Elastography in Evaluation of Suspicious Breast Masses

Authors: Zahraa Majid Abdulamir Almosawi --- Kassim Amir Hadi Taj-aldean --- Hadi Mohamed Ali Almusawi --- Ali A. Kadhim Abutiheen
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2017 Volume: 14 Issue: 4 Pages: 616 -626
Publisher: Babylon University جامعة بابل

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Abstract

Breast cancer is the most prevalent type of cancer in Iraq, and the commonest among females worldwide. Ultrasound is an important widely used noninvasive modality in line with mammography and other methods for the detection and characterization of breast masses in routine clinical practice. Elastography is a recent promising method used as an adjuvant to ultrasound that improves performance, increase the specificity of interpretation in differentiating benign from malignant breast masses based on imaging tissue stiffness. We aim to evaluate the accuracy of ultrasound and elastography in diagnosis of suspicious malignant breast masses. A cross sectional study was conducted in Babylon and Kerbala January 15 to August 20, 2017. A consecutive sample of women with breast mass suggestive of malignancy were evaluated with ultrasonography and strain elastography prior to histopathological study. The five point Tsukuba elasticity score were used for differentiation of breast masses. Ethical approval was taken from the Research Ethical Committee in Babylon University- College of Medicine, and verbal consent was taken from each patient prior to enrolment. A total sample of (88) females with breast mass aged 16-69 years with a mean ± SD of 41.33 ± 12.57 years. Ultrasound diagnosed correctly (58) out of the (62) malignant breast masses with a sensitivity and specificity of 93.5% and 100% respectively. By using strain elastography the sensitivity increased to 98.4% with same specificity of 100% were only one malignant mass was missed. By using the ROC analysis, the Area Under the Curve and 95% confidence interval was 0.968 (0.931-1) and 0.992 (0.974-1) for ultrasound and elastography respectively. So when elastography is used with ultrasound, it increases its sensitivity, specificity and accuracy. Efforts needed to adapt and apply its use properly in Iraq through training programs for radiologists.

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