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Li G, Li Q, Wu H, Huang Z, Tian H, Yang K, Chen J, Xu J, Yuan L, Dong F. Multi-center strain elastography radiomics for breast cancer diagnosis: integrating intratumoral and peritumoral regions. Discov Oncol 2025; 16:659. [PMID: 40316866 PMCID: PMC12048382 DOI: 10.1007/s12672-025-02406-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Accepted: 04/16/2025] [Indexed: 05/04/2025] Open
Abstract
OBJECTIVES This study aimed to develop and validate a novel strain elastography (SE) radiomics nomogram for diagnosing breast cancer (BC) by analyzing intratumoral and peritumoral regions. METHODS A cohort of 322 patients, comprising 217 from hospital #1 (06/2021-05/2023) and 105 from hospital #2 (06/2022-05/2023) with breast lesions, was enrolled. Radiomic features were extracted from intratumoral and peritumoral (0-1 mm, 1-2 mm, 2-3 mm) regions on strain elastography images. Significant features were selected using Mann-Whitney U test, Spearman's correlation coefficient, and LASSO logistic regression. A radiomic model was constructed utilizing these features, followed by the development of a radiomic nomogram integrating optimal features. RESULTS The intratumoral radiomic model exhibited an area under the receiver operating characteristic curve (AUC) of 0.774 (95% CI: 0.626-0.922) in the internal testing set. Combining peritumoral radiomics, the intratumoral & peritumoral_0-1 mm radiomic model emerged as the optimal model with an AUC of 0.884 (95% CI: 0.766-0.998) in the internal testing set, signifying improved BC identification. The optimal model demonstrated an AUC of 0.841 (95% CI: 0.762-0.920) in the external testing set, indicating robustness and generalization. CONCLUSIONS The radiomic model incorporating intratumoral & peritumoral_0-1 mm radiomic features shows promise in diagnosing BC, aiding in devising effective clinical treatment strategies.
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Affiliation(s)
- Guoqiu Li
- The Second Clinical Medical College of Jinan University, Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong Province, China
| | - Qiaoying Li
- Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shanxi Province, China
| | - Huaiyu Wu
- The Second Clinical Medical College of Jinan University, Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong Province, China
| | - Zhibin Huang
- The Second Clinical Medical College of Jinan University, Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong Province, China
| | - Hongtian Tian
- The Second Clinical Medical College of Jinan University, Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong Province, China
| | - Keen Yang
- The Second Clinical Medical College of Jinan University, Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong Province, China
| | - Jing Chen
- The Second Clinical Medical College of Jinan University, Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong Province, China
| | - Jinfeng Xu
- The Second Clinical Medical College of Jinan University, Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong Province, China.
| | - Lijun Yuan
- Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shanxi Province, China.
| | - Fajin Dong
- The Second Clinical Medical College of Jinan University, Department of Ultrasound, Shenzhen People's Hospital, Shenzhen, 518020, Guangdong Province, China.
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Gu Y, Tian J, Ran H, Ren W, Chang C, Yuan J, Kang C, Deng Y, Wang H, Luo B, Guo S, Zhou Q, Xue E, Zhan W, Zhou Q, Li J, Zhou P, Zhang C, Chen M, Gu Y, Xu J, Chen W, Zhang Y, Li J, Wang H, Jiang Y. Ultrasound strain elastography to improve diagnostic performance of breast lesions by reclassifying BI-RADS 3 and 4a lesions: a multicentre diagnostic study. Br J Radiol 2025; 98:89-99. [PMID: 39388198 DOI: 10.1093/bjr/tqae197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/12/2024] [Accepted: 09/21/2024] [Indexed: 10/15/2024] Open
Abstract
OBJECTIVES To investigate the added value of strain elastography (SE) by recategorizing ultrasound (US) breast imaging reporting and data system (BI-RADS) 3 and 4a lesions. METHODS A total of 4371 patients underwent US and SE with BI-RADS 2-5 categories solid breast lesions were included from 32 hospitals. We evaluated the elastographic images according to elasticity scores (ES) and strain ratios (SR). Three combined methods (BI-RADS + ES, BI-RADS + SR, BI-RADS + ES + SR) and two reclassified methods were used (method one: upgrading BI-RADS 3 and downgrading BI-RADS 4a, method two: downgrading BI-RADS 4a alone). The diagnostic performance and the potential reduction of unnecessary biopsies were evaluated. RESULTS Combining BI-RADS with SE had a higher area under the curve (AUC) than BI-RADS alone (0.822-0.898 vs 0.794, P < .01). For reclassified method one, the sensitivity, specificity, and accuracy were 99.36%, 66.70%, 78.36% for BI-RADS + ES and 98.01%, 66.45%, 77.72% for BI-RADS + SR, and 99.42%, 66.70%, 78.38% for BI-RADS + ES + SR, respectively. For reclassified method two, the sensitivity, specificity, and accuracy were 99.17%, 70.72%, 80.87% for BI-RADS + ES and 97.76%, 81.75%, 87.46% for BI-RADS + SR, and 99.23%, 69.83%, 80.32% for BI-RADS + ES + SR, respectively. Downgrading BI-RADS 4a alone had higher AUC, specificity, and accuracy (P < .01) and similar sensitivity (P > .05) to upgrading BI-RADS 3 and downgrading BI-RADS 4a. Combining SE with BI-RADS could help reduce unnecessary biopsies by 17.64%-55.20%. CONCLUSIONS Combining BI-RADS with SE improved the diagnostic performance in distinguishing benign from malignant lesions and could decrease false-positive breast biopsy rates. Downgrading BI-RADS 4a lesions alone might be sufficient for achieving good diagnostic performance. ADVANCES IN KNOWLEDGE Downgrading BI-RADS category 4a lesions alone had higher AUC, specificity, and accuracy, and similar sensitivity to upgrading or downgrading BI-RADS category 3 and 4a lesions.
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Affiliation(s)
- Yang Gu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou 215000, China
| | - Jiawei Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Haitao Ran
- Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University & Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Cai Chang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Jianjun Yuan
- Department of Ultrasonography, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Chunsong Kang
- Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, China
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun130033, China
| | - Baoming Luo
- Department of Ultrasound, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Shenglan Guo
- Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Qi Zhou
- Department of Medical Ultrasound, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, China
| | - Ensheng Xue
- Department of Ultrasound, Union Hospital of Fujian Medical University, Fujian Institute of Ultrasound Medicine, Fuzhou 350001, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
| | - Qing Zhou
- Department of Ultrasonography, Renmin Hospital of Wuhan University, Wuhan 430060, China
| | - Jie Li
- Department of Ultrasound, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha 410013, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Man Chen
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Ying Gu
- Department of Ultrasonography, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen 518020, China
| | - Wu Chen
- Department of Ultrasound, The First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Yuhong Zhang
- Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian 116027, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hongyan Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yuxin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Li X, Zhang L, Li Y, Jiang Y, Zhao C, Fang S, Yang Z, Sun L. Assessment of perineal body properties in women with stress urinary incontinence using Transperineal shear wave elastography. Sci Rep 2024; 14:21647. [PMID: 39289423 PMCID: PMC11408648 DOI: 10.1038/s41598-024-72429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024] Open
Abstract
Limited data on the correlation between the perineal body (PB) and stress urinary incontinence (SUI) are available. The objectives of this study were to quantify the PB using shear wave elastography (SWE) technology with a high-frequency linear array probe to evaluate the relationship between the properties of PB and stress urinary incontinence (SUI). This study included 64 women with SUI and 70 female control participants. The length, height, perimeter, and area of PB in all participants were calculated using transperineal ultrasound, and the elasticity of PB was assessed by SWE at rest and during the maximal Valsalva maneuver, respectively. In addition, the comparison of PB parameters between the patients with SUI and the healthy participants was conducted. The transperineal ultrasound and SWE examination was performed in 134 participants, and the elastic modulus values were significantly increased from participants at rest to those during the maximal Valsalva maneuver in all participants (Emax: 35.59 versus 53.13 kPa, P < 0.001; and Emean: 26.97 versus 40.25 kPa, P < 0.001). Emax and Emean of PB exhibited significant differences during the maximal Valsalva maneuver between the SUI group and the control group (47.73 versus 58.06 kPa, P < 0.001; and 35.78 versus 44.33 kPa, P < 0.001) and had a negative correlation with SUI. The BMI and PB height during the maximal Valsalva maneuver in the SUI group were found to be significantly higher than that in healthy volunteers. Emax and Emean of PB negatively correlated with BMI during the maximal Valsalva maneuver (r = -0.277, P = 0.001 and r = -0.211, P = 0.014). ROC curve analysis demonstrated that PB perimeter of less than 12.68mm was strongly associated with SUI during the maximal Valsalva maneuver, and an Emax of less than 55.76 kPa had a 100% specificity in predicting SUI. SWE can quantify the elasticity of PB, identifying a significant difference between participants at rest and during Valsalva maneuver. In addition, the stiffness of the PB was significantly lower in women with SUI than in healthy women, which may provide a noninvasive clinical practice in SUI prediction.
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Affiliation(s)
- Xiumei Li
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Limin Zhang
- Department of Ultrasound, Maternity and Child Health Care of Zaozhuang, Zaozhuang, 277100, China
| | - Yong Li
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Yushan Jiang
- Department of Ultrasound, Jimo District People's Hospital of Qingdao, Qingdao, 266200, China
| | - Cheng Zhao
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Shibao Fang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Zongli Yang
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China.
| | - Liwen Sun
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
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Liao J, Gui Y, Li Z, Deng Z, Han X, Tian H, Cai L, Liu X, Tang C, Liu J, Wei Y, Hu L, Niu F, Liu J, Yang X, Li S, Cui X, Wu X, Chen Q, Wan A, Jiang J, Zhang Y, Luo X, Wang P, Cai Z, Chen L. Artificial intelligence-assisted ultrasound image analysis to discriminate early breast cancer in Chinese population: a retrospective, multicentre, cohort study. EClinicalMedicine 2023; 60:102001. [PMID: 37251632 PMCID: PMC10220307 DOI: 10.1016/j.eclinm.2023.102001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Background Early diagnosis of breast cancer has always been a difficult clinical challenge. We developed a deep-learning model EDL-BC to discriminate early breast cancer with ultrasound (US) benign findings. This study aimed to investigate how the EDL-BC model could help radiologists improve the detection rate of early breast cancer while reducing misdiagnosis. Methods In this retrospective, multicentre cohort study, we developed an ensemble deep learning model called EDL-BC based on deep convolutional neural networks. The EDL-BC model was trained and internally validated on B-mode and color Doppler US image of 7955 lesions from 6795 patients between January 1, 2015 and December 31, 2021 in the First Affiliated Hospital of Army Medical University (SW), Chongqing, China. The model was assessed by internal and external validations, and outperformed radiologists. The model performance was validated in two independent external validation cohorts included 448 lesions from 391 patients between January 1 to December 31, 2021 in the Tangshan People's Hospital (TS), Chongqing, China, and 245 lesions from 235 patients between January 1 to December 31, 2021 in the Dazu People's Hospital (DZ), Chongqing, China. All lesions in the training and total validation cohort were US benign findings during screening and biopsy-confirmed malignant, benign, and benign with 3-year follow-up records. Six radiologists performed the clinical diagnostic performance of EDL-BC, and six radiologists independently reviewed the retrospective datasets on a web-based rating platform. Findings The area under the receiver operating characteristic curve (AUC) of the internal validation cohort and two independent external validation cohorts for EDL-BC was 0.950 (95% confidence interval [CI]: 0.909-0.969), 0.956 (95% [CI]: 0.939-0.971), and 0.907 (95% [CI]: 0.877-0.938), respectively. The sensitivity values were 94.4% (95% [CI]: 72.7%-99.9%), 100% (95% [CI]: 69.2%-100%), and 80% (95% [CI]: 28.4%-99.5%), respectively, at 0.76. The AUC for accurate diagnosis of EDL-BC (0.945 [95% [CI]: 0.933-0.965]) and radiologists with artificial intelligence (AI) assistance (0.899 [95% [CI]: 0.883-0.913]) was significantly higher than that of the radiologists without AI assistance (0.716 [95% [CI]: 0.693-0.738]; p < 0.0001). Furthermore, there were no significant differences between the EDL-BC model and radiologists with AI assistance (p = 0.099). Interpretation EDL-BC can identify subtle but informative elements on US images of breast lesions and can significantly improve radiologists' diagnostic performance for identifying patients with early breast cancer and benefiting the clinical practice. Funding The National Key R&D Program of China.
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Affiliation(s)
- Jianwei Liao
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Yu Gui
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Zhilin Li
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Zijian Deng
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Xianfeng Han
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Huanhuan Tian
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Li Cai
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Xingyu Liu
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Chengyong Tang
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Jia Liu
- Department of Gastroenterology, The First Affiliated Hospital (Southwest Hospital) of Third Military Medical University (Army Medical University), Chongqing, 40038, China
| | - Ya Wei
- The Third Department of General Surgery, Anyang Cancer Hospital, Henan, 455001, China
| | - Lan Hu
- Department of General Surgery, The People's Hospital of Dazu, Chongqing, 402360, China
| | - Fengling Niu
- Breast Surgery Department, Tangshan People's Hospital, Tangshan, 063001, China
| | - Jing Liu
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Xi Yang
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Shichao Li
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Xiang Cui
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Xin Wu
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Qingqiu Chen
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Andi Wan
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Jun Jiang
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Yi Zhang
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Xiangdong Luo
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
| | - Peng Wang
- Centre for Medical Big Data and Artificial Intelligence, Southwest Hospital of Third Military Medical University, Chongqing, 400038, China
| | - Zhigang Cai
- College of Computer and Information Science, Southwest University, Chongqing, 400715, China
| | - Li Chen
- Department of Breast and Thyroid Surgery, Southwest Hospital of Third Military Medical University, Chongqing, 40038, China
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Wang A, Zhong J, Wang S, Wang H, Tao L, Wei H, Chen X, Zhou X, Sun J. Different precompression does not reduce the diagnostic value of virtual touch tissue imaging and quantification (VTIQ) in breast lesions, especially for the ratio of the shear wave velocity between lesions and surrounding tissues. Eur J Radiol 2022; 151:110284. [PMID: 35390603 DOI: 10.1016/j.ejrad.2022.110284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the accuracy of virtual touch tissue imaging and quantification (VTIQ) in the diagnosis of benign and malignant breast lesions under four different precompression levels. The shear wave velocity (SWV) ratios of lesion to surrounding tissue were also added for diagnosis. METHODS 167 female patients with breast lesions were included in this single center prospective study. VTIQ was performed under four different precompression levels. The SWV of the lesion, surrounding fat, and gland tissue were measured at the same depth as much as feasible 7 times. The breast lesions studied were all histopathologically confirmed. The VTIQ parameters were compared between precompression levels. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the diagnostic performance of each parameter of the VTIQ. RESULTS The VTIQ parameters of the malignant lesions were significantly higher than those of benign lesions in all precompression levels (P < 0.001). SWV of the lesion, fat, and gland tissue increased significantly with increasing precompression. The VTIQ parameters had great diagnostic performance for breast lesions in all precompression levels (AUC = 0.765-0.911). There was no significant difference between the precompression levels of the lesion-to-fat SWV ratio and the lesion-to-gland SWV ratio in benign and malignant lesions, and the cut-off coefficients of variation were 7.42% and 8.55%, respectively. CONCLUSIONS Precompression can increase the stiffness of breast lesions, fat and gland tissues, but does not reduce diagnostic value of VTIQ parameters in the breast. Under different precompression levels, the diagnosis of breast lesions by the ratio of the SWV of the lesion to the surrounding tissues is more stable.
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Affiliation(s)
- Achen Wang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China
| | - Jingwen Zhong
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China
| | - Shuhan Wang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China
| | - Hongbo Wang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China
| | - Lin Tao
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China
| | - Hong Wei
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China
| | - Xi Chen
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China
| | - Xianli Zhou
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China.
| | - Jiawei Sun
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin 150086, China.
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Sakalecha AK, Parameshwar KBH, Savagave SG, Naik BR. The Role of Ultrasonography and Elastography in Differentiating Benign From Malignant Breast Masses With Pathologic Correlation. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793211073682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Elastography has the potential in differentiating benign from malignant masses. The objectives of the study were to evaluate morphology of the breast masses with routine ultrasonography and elastography, to assess the role of elastography and conventional B-mode ultrasonography in differentiating benign from malignant breast masses and to correlate elastography and B-mode ultrasonography results with pathologic findings. Materials and Methods: This prospective observational study was conducted over a period of 18 months from January 2018 to June 2019 on 86 patients with 101 clinically palpable breast lumps who underwent B-mode ultrasonography and elastography of the breast. Baseline data, sonographic features, a modified color score, and mean strain ratio were recorded and compared with final diagnosis. Results: Sonography showed a sensitivity of 89.8%; specificity of 96.15%; positive predictive value (PPV) and negative predictive value (NPV) of 95.65% and 90.91%, respectively; and overall diagnostic accuracy of 93.07%. New modified dual color score showed sensitivity of 97.8%, specificity of 87.0%, PPV of 86.79%, and NPV of 87.08% with a diagnostic accuracy of 92.08%. The risk of missing a malignant case with the new modified dual color score was 2.1%. Mean strain ratio showed sensitivity of 100%; specificity of 98.11%; PPV and NPV of 97.96% and 100%, respectively; and diagnostic accuracy of 99.01%. Conclusion: This study demonstrates the promise of elastography in identifying possible breast malignancies, thus preventing unnecessary invasive procedures.
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Affiliation(s)
- Anil Kumar Sakalecha
- Department of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Keerthi B H Parameshwar
- Department of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Shivaprasad G. Savagave
- Department of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Bukke Ravindra Naik
- Department of Radiology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
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Turnaoğlu H, Haberal KM, Arslan S, Yavuz Çolak M, Ulu Öztürk F, Uslu N. Interobserver and intermethod variability in data interpretation of breast strain elastography in suspicious breast lesions. Turk J Med Sci 2021; 51:547-554. [PMID: 32950046 PMCID: PMC8203122 DOI: 10.3906/sag-2006-257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022] Open
Abstract
Background/aim Strain elastography has the disadvantage of being operator-dependent. Interobserver variability is observed during image acquisition and interpretation. This study aimed to analyze the interobserver and intermethod variability of strain elastography in image interpretation and evaluate the diagnostic performance combining elasticity score and strain ratio with ultrasonography. Materials and methods A retrospective study was conducted on 70 breast lesions evaluated with B-mode ultrasonography and strain elastography. B-mode ultrasonography findings, elasticity scores, and strain ratio values were evaluated using static images by two radiologists. BI-RADS assessment of the lesions and the decision of both observers as to whether the biopsy was required using B-mode ultrasonography, and the combined ultrasonography+elasticity score, and the combined ultrasonography+elasticity score+strain ratio were compared with the histopathological results. Also, the interobserver agreement was analyzed for all the combinations. Results There was very good agreement (weighted κ = 0.865) between the observers for the elasticity scores. Very good agreement was observed between the observers for BI-RADS assessments using the combined ultrasonography+elasticity score and the combined ultrasonography+elasticity score+strain ratio (weighted κ = 0.848, and 0.902, respectively). Area under the curve of B-mode ultrasonography, the combined B-mode ultrasonography+elasticity score, and the combined B-mode ultrasonography+elasticity score+strain ratio, were calculated as 0.859, 0.866, and 0.916 for observer 1, and 0.851, 0.829, and 0.916 for observer 2, respectively. There were no statistically significant differences between the observers’ diagnostic performances in any of the combinations (P = 0.703, 0.067, and 0.972, respectively). Conclusion In the evaluation and further assessment of breast lesions, semiquantitative strain ratio calculation may help improve diagnostic accuracy by reducing interpretational variety, when used together with B-mode ultrasonography and elasticity scoring, especially for inexperienced individuals.
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Affiliation(s)
- Hale Turnaoğlu
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Kemal Murat Haberal
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Serdar Arslan
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
- Department of Radiology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Meriç Yavuz Çolak
- Department of Biostatistics, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Funda Ulu Öztürk
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Nihal Uslu
- Department of Radiology, Faculty of Medicine, Başkent University, Ankara, Turkey
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Woo JH, Ko EY, Han BK. Comparison of 2 shear wave elastography systems in reproducibility and accuracy using an elasticity phantom. Medicine (Baltimore) 2021; 100:e24921. [PMID: 33847610 PMCID: PMC8052081 DOI: 10.1097/md.0000000000024921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 02/04/2021] [Indexed: 11/26/2022] Open
Abstract
This study aimed to compare the accuracy and inter- and intra-observer reproducibility of the measured elasticity between 2 shear wave elastography systems. Three breast radiologists examined 8 targets of 4 different levels of stiffness (size: 11 mm, 4 mm) in an elasticity phantom (Customized 049A Elasticity QA Phantom, CIRS, Norfolk, VA, USA) using 2 different shear wave ultrasound elastography systems: SuperSonic Imagine (SSI) (SSI, Aix en Provence, France) and ShearScan (RS-80A, Samsung Medison, Seoul, Korea). Three radiologists performed ultrasound (US) elastography examinations for the phantom lesions using 2 equipment over a 1-week interval. Intra- and inter-observer reproducibility and the accuracy of the measured elasticity were analyzed and compared between the 2 systems. The accuracy of shape was also analyzed by shape-matching between B-mode and elastography color image. Intra-class correlation coefficients (ICC) were used in statistical analysis. For measured elasticity, the intra-observer and inter-observer reproducibility were excellent in both SSI and ShearScan (0.994 and 0.998). The overall accuracy was excellent in both systems, but the accuracy in small lesions (4 mm target) was lower in SSI than ShearScan (0.780 vs 0.967). The accuracy of shape-matching on the elastography image was 59.0% and 81.4% in the SSI and ShearScan, respectively. In conclusion, the SSI and ShearScan showed excellent intra- and inter-observer reproducibility. The accuracy of the Young's modulus was high in both the SSI and ShearScan, but the SSI showed decreased accuracy in measurement of elasticity in small targets and poor shape-matching between the B-mode image and color-coded elastography image.
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Abstract
BACKGROUND Elasticity assessment of breast lesions can also be used as an associated criterion in the B‑mode ultrasound (US) assessment for differentiation between benign or malignant lesions. OBJECTIVES The goal was to identify techniques available to measure US elasticity, assess the use of B‑mode BI-RADS® classification combined with elastography, and identify which artefacts influence the US elasticity result. MATERIALS AND METHODS Based on different studies and meta-analyses, clinical application in daily routine of the presented US elastography techniques will be investigated concerning the statistical performance of semi-quantitative and quantitative cut-off values to differentiate benign from malignant lesions. RESULTS Supported by meta-analyses, all presented US elastography techniques improve the specificity by decreasing the B‑mode sensitivity. In the literature the semi-quantitative and quantitative cut-off values often vary considerably. The interobserver variability of strain elastography shows a fair agreement and the interobserver variability of shear wave elastography a substantial agreement. CONCLUSIONS Considering the limitations and artefacts of each technique, US elastography is able to enhance the true positive and true negative results. In the case of a higher B‑mode BI-RADS® classification (4b, 4c, 5) or in a high-risk situation to develop breast cancer, a large core needle biopsy should be performed despite lesion softness in elastography.
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Affiliation(s)
- Christian Weismann
- Universitätsinstitut für Radiologie der PMU, Mammadiagnostik u. Mammaintervention, Uniklinikum Salzburg, Landeskrankenhaus, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
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Zhang L, Dong YJ, Zhou JQ, Jia XH, Li S, Zhan WW. Similar Reproducibility for Strain and Shear Wave Elastography in Breast Mass Evaluation: A Prospective Study Using the Same Ultrasound System. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:981-991. [PMID: 31980291 DOI: 10.1016/j.ultrasmedbio.2019.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
The objective of this study was to evaluate the inter-operator reproducibility of strain elastography (SE) and shear wave elastography (SWE) in three groups: all lesions, benign lesions and malignant lesions. Ninety-one lesions from ninety-one women were examined by SE and SWE from January 2017 to December 2017 by two radiologists. The reproducibility of elastic score, SE strain ratio and SWE Young's modulus between operators was prospectively evaluated. There was good agreement on elasticity score, with κ values of 0.711, 0.640 and 0.766. The intra-class correlation coefficients of the strain ratio, mean elastic modulus (Emean), maximum elastic modulus (Emax) and elastic modulus standard deviation (Esd) ranged from 0.723-0.876, which indicated good and excellent agreement. We concluded that both SE and SWE had good reproducibility among different operators using the same probe in the same ultrasound instrument. Strain elasticity score was more consistent among operators in malignant breast tumors. There was better agreement on strain elastic ratio and shear wave elasticity among operators in benign breast lesions.
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Affiliation(s)
- Lu Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-Jie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Qiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiao-Hong Jia
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - ShuangShuang Li
- Ultrasound Imaging System Development Department, Shenzhen Mindray Bio-Medical Electronics Co. Ltd, Nanshan, Shenzhen, China
| | - Wei-Wei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Mesurolle B, El Khoury M, Chammings F, Zhang M, Sun S. Breast sonoelastography: Now and in the future. Diagn Interv Imaging 2019; 100:567-577. [PMID: 30935864 DOI: 10.1016/j.diii.2019.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to identify practice trends and opinions concerning breast sonoelastography in two different health care systems, one in Europe (France) and the other in North America (Province of Québec/Canada). MATERIALS AND METHODS We distributed an 11-item online survey among French and Canadian breast radiologists. The survey comprised of four sections: (i) personal practice characteristics, (ii) breast sonoelastography usage in daily practice and evaluation of its usefulness, (iii) limitations and roles of sonoelastogrpahy in their clinical practice, and (iv) types of elastographic technique and interpretation. RESULTS We found that sonoelastography of the breast appears unpopular among Canadian radiologists, and poorly credible among French radiologists, who perceive it as an unreliable technique. To date, its real impact in clinical practice remains uncertain. CONCLUSION Continued learning and awareness of the indications, advantages and limitations of breast sonoelastography may motivate breast radiologists to adopt its use.
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Affiliation(s)
- B Mesurolle
- Department of Radiology, centre république, Elsan, 99, avenue de la république, 63023 Clermont-Ferrand, France.
| | - M El Khoury
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
| | - F Chammings
- Unité de radio-sénologie, department of radiology, institut Bergonié, 33000 Bordeaux, France
| | - M Zhang
- Breast Clinic, McGill University Health Center, Montreal, Québec, Canada
| | - S Sun
- Breast Clinic, McGill University Health Center, Montreal, Québec, Canada
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Song Y, Zhou J. Response to Letter Regarding Article ‘Breast strain elastography: Observer variability in data acquisition and interpretation’. Eur J Radiol 2018; 106:183. [DOI: 10.1016/j.ejrad.2018.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Observer reproducibility of breast strain elastography in data acquisition and interpretation: A methodological issue. Eur J Radiol 2018; 106:210. [PMID: 29970273 DOI: 10.1016/j.ejrad.2018.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/02/2018] [Indexed: 11/21/2022]
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