Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world

The diagnostic value of real-time ultrasound elastography and contrast-enhanced ultrasound in BI-RADS 4A breast lesions

Background

The Breast Imaging-Reporting and Data System (BI-RADS) is the primary system for classifying clinical breast lesions. Most early lesions identified via ultrasound are classified as BI-RADS 4A or lower. Although the vast majority of BI-RADS 4A lesions are benign, those lesions still have the possibility of malignancy in clinical practice, which is a controversial and noteworthy issue. This study aimed to assess the diagnostic value of real-time ultrasound elastography (UE) and contrast-enhanced ultrasound (CEUS) in evaluating BI-RADS 4A breast lesions.

Methods

A retrospective analysis was conducted of the UE and CEUS data of 52 BI-RADS 4A breast lesions from 52 patients between January 2020 and March 2023. All diagnoses were confirmed by surgical pathology. Lesion characteristics, including the margins, echogenicity, size, microcalcifications, blood flow patterns, UE scores, and CEUS features, were analyzed. CEUS scores were based on a five-point system, and the area under the curve (AUC) was calculated using MedCalc version 19.0.4.

Results

Based on the postoperative pathology, of the 52 lesions, 27 were benign and 25 were malignant. Compared to those with benign lesions, the patients with malignant lesions were older and had larger lesions (P<0.05). Features such as irregular morphology, indistinct margins, increased blood flow, and calcifications were more common in the malignant lesions than the benign lesions (P<0.05). The malignant lesions also had a higher prevalence of inhomogeneous enhancement, vasa vasorum, irregular enhanced morphology, and crab claw-like signs on CEUS than the benign lesions (P<0.05). The diagnostic accuracy of both the UE and CEUS individually was 76.9%, while the diagnostic accuracy of the UE and CEUS combined reached 80.8%. The AUCs of UE, CEUS, and the UE and CEUS combined were 0.761, 0.773, and 0.813, respectively.

Conclusions

UE and CEUS have significant diagnostic value for BI-RADS 4A breast lesions. Combining these techniques improves diagnostic accuracy and can help reduce unnecessary biopsies.

Effectiveness of shear wave elastography for assessing major salivary gland involvement in ankylosing spondylitis

Objective

To use shear wave elastography (SWE) in the evaluation of salivary glands in patients with ankylosing spondylitis (AS) who present with sicca symptoms.

Materials and Methods

This was a prospective controlled study of patients diagnosed with AS and exhibiting sicca symptoms (study group) and of healthy volunteers (control group). The levels of antinuclear, anti-Ro, and anti-La antibodies were determined in blood samples. In both groups, parotid and submandibular glands were evaluated by ultrasound and tissue stiffness was determined by SWE. Intraclass correlation coefficients were used in order to assess reliability. The differences between the two groups were assessed by statistical methods, and a ROC curve analysis was performed to determine the predictive values.

Results

A total of 66 patients with AS and 71 healthy volunteers were included in the study. There were no significant differences between the groups in terms of age or sex (p > 0.05). The intraand inter-rater reliability of SWE were good for the parotid gland (0.81-0.85 and 0.80, respectively) and for the submandibular gland (0.85-0.88 and 0.80, respectively). Statistically significant differences were found. Tissue stiffness in the parotid and submandibular glands, as determined by SWE, was significantly greater in the study group than in the control group (p < 0.05).

Conclusion

Although there was no histopathological correlation in the parotid and submandibular salivary glands of patients with AS and sicca symptoms compared with the healthy volunteers, quantitative measurements showed greater tissue stiffness in the former group. In patients with AS, SWE guides salivary gland biopsy, which is the gold standard for diagnosing Sjögren's syndrome.

Breast multiparametric ultrasound: a single-center experience

PURPOSE

To evaluate the role of multiparametric ultrasound (mpUS) in the characterization of focal breast lesions (FBLs).

METHODS

This prospective study enrolled patients undergoing multiparametric breast ultrasound for FBLs. An experienced breast radiologist evaluated the following ultrasound features: US BI-RADS category, vascularization pattern (internal, vessels in rim and combined) and presence of penetrating vessels with each Doppler method (Color-Doppler, Power-Doppler, Microvascular imaging), strain ratio (SR) and Tsukuba score (TS) with Strain Elastography (SE), Emax, Emean, Emin and Eratio with 2D-shear wave elastography (2D-SWE). Core biopsy for all BI-RADS 4-5 FBLs and 24-month follow-up for all BI-RADS 2-3 FBLs were considered for standard of reference. The diagnostic performance was assessed with the area under curve (AUCs) and cut-off values were determined according to the Youden's index.

RESULTS

A total of 139 FBLs were included with 75/139 (53.9%) benign and 64/139 (46.1%) malignant FBLs. Internal vascularization patterns (p < 0.001), penetrating vessels (p < 0.001), TS 4-5 (p < 0.001) and all 2D-SWE parameters (p < 0.001) were significantly different between benign and malignant FBLs. The BI-RADS score provided an AUC of 0.876 (95% CI 0.810-0.926) for the diagnosis of malignant FBLs. Among the 2D-SWE measurements, an excellent diagnostic performance was observed for Emax with an AUC of 0.915 (95% CI 0.856-0.956) and Emean of 0.908 (95% CI 0.847-0.951). Optimal cutoff for the diagnosis of malignant FBLs were US BI-RADS > 3, Strain Ratio > 2.52, Tsukuba Score > 3, Emax > 82.6 kPa, Emean > 66.0 kPa, Emin > 54.4 kPa and Eratio > 330.8. Multiparametric ultrasound, particularly SWE, can improve specificity in the characterization of FBLs.

A Model Combining Conventional Ultrasound Characteristics, Strain Elastography and Clinicopathological Features to Predict Ki-67 Expression in Small Breast Cancer

To establish a predictive model incorporating conventional ultrasound, strain elastography and clinicopathological features for Ki-67 expression in small breast cancer (SBC) which defined as maximum diameter less than2 cm. In this retrospective study, 165 SBC patients from our hospital were allocated to a high Ki-67 group (n = 104) and a low Ki-67 group (n = 61). Multivariate regression analysis was performed to identify independent indicators for developing predictive models. The area under the receiver operating characteristic (AUC) curve was also determined to establish the diagnostic performance of different predictive models. The corresponding sensitivities and specificities of different models at the cutoff value were compared. Conventional ultrasound parameters (spiculated margin, absence of posterior shadowing and Adler grade 2-3), strain elastic scores and clinicopathological information (HER2 positive) were significantly correlated with high expression of Ki-67 in SBC (all p < .05). Model 2, which incorporated conventional ultrasound features and strain elastic scores, yielded good diagnostic performance (AUC = 0.774) with better sensitivity than model 1, which only incorporated ultrasound characteristics (78.85%vs. 55.77%, p = .000), with specificities of 77.05% and 62.30% (p = .035), respectively. Model 3, which incorporated conventional ultrasound, strain elastography and clinicopathological features, yielded better performance (AUC = 0.853) than model 1 (AUC = 0.694) and model 2 (AUC = 0.774), and the specificity was higher than model 1 (86.89% vs. 77.05%, p = .001). The predictive model combining conventional ultrasound, strain elastic scores and clinicopathological features could improve the predictive performance of Ki-67 expression in SBC.