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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
11.COMBINING STRAIN ELASTOGRAPHY FINDINGS WITH ULTRASOUND BIRADS SYSTEM TO DISCRIMINATE BETWEEN BENIGN AND MALIGNANT SOLID BREAST MASSES

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Abstract

Background:Elastography has been attracting attention as a new non-invasive diagnostic tool with the potential to improve breast masses characterization.Objective:To assess the value of incorporating strain elastography into the ultrasound Breast Imaging Reporting and Data System (BIRADS) System to differentiate benign from malignant breast masses.Methods:Fifty-six women with 61 solid breast masses were enrolled in this study. Ultrasound was performed and the mass was given an US BIRADS category. Elastographic examination was performed and each lesion was assigned an Elasticity Score (ES) according to the Tsukuba scoring system. Strain Ratios (SRs) were calculated from a tumor adjusted Region of Interest (ROI) and a reference ROI in the fatty tissue. The US BIRADS was modified according to the elasticity criteria. Sensitivity, specificity, area under the curve (AUC) and cutoff values were calculated for US BIRADS, ES, SR and the modified BIRADS method using (ROC) curve analysis. Results:The final results were based on 61 masses, 25 benign and 36 malignant. The sensitivity and specificity were respectively (97% and 80%) for US BIRADS, (86.1% and 84%) for ES, (94.44% and 84%) for SR, and (97% and 84%) for the modified BIRADS. Conclusion:Combining elastography with conventional ultrasound yielded better diagnostic performance with improved specificity.Keywords:Elastography, breast masses, elasticity, strain ratio, modified BIRADSCitation:Tawfeeq RHA, Khalel EA, Al-Waely NKN. Combining strain elastography findings with ultrasound BIRADS system to discriminate between benign and malignant solid breast masses. Iraqi JMS. 2018; Vol. 16(1): 74-83. doi: 10.22578/IJMS.16.1.11

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