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Dai X, Sui X, Chen S, Zhao B, Liu Z, Wang X. The diagnostic performance of salivary gland ultrasound elastography in Sjögren's syndrome and sicca symptoms: a systematic review and meta-analysis. Eur Radiol 2024; 34:1545-1555. [PMID: 37658892 DOI: 10.1007/s00330-023-10166-5] [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: 03/16/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To systematically evaluate the diagnostic performance of ultrasound elastography (USE) in distinguishing primary Sjögren's syndrome (pSS) from healthy/disease controls. METHODS We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for published literature on USE for diagnosing pSS. Bivariate random effects models were used to calculate the pooled sensitivity and specificity of USE. To determine the factors influencing heterogeneity, meta-regression and subgroup analyses were performed to assess country, diagnostic criteria, imaging mechanisms, shear wave elastography techniques, measurement location, control group category, and patient age. Publication bias was assessed using the asymmetry of the Deeks funnel plot. RESULTS Fifteen articles covering 816 patients and 735 control participants were included. USE showed a pooled sensitivity of 0.80 (95% CI: 0.71-0.87) and specificity of 0.87 (95% CI: 0.78-0.92). Meta-regression and subgroup analyses revealed that shear wave elastography techniques, measurement location, and patient age were significant factors that affected study heterogeneity (p < 0.05). Elastography performs better in diagnosing patients aged ≤ 51 years compared to patients aged > 51 years. There was no significant publication bias. CONCLUSION USE demonstrates high accuracy in differentiating between pSS and healthy/disease control groups. CLINICAL RELEVANCE STATEMENT Ultrasound elastography, as a non-invasive and cost-effective technique, can be used to distinguish primary Sjögren's syndrome from disease/healthy control groups by measuring the stiffness of salivary glands. KEY POINTS • Ultrasound elastography is an acceptable technique for the diagnosis of primary Sjögren's syndrome. • The pooled sensitivity and specificity of ultrasound elastography for diagnosing primary Sjögren's syndrome were 0.80 and 0.87, respectively. • In patients aged ≤ 51 years with primary Sjögren's syndrome, ultrasound elastography showed good diagnostic performance.
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Affiliation(s)
- Xinpeng Dai
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China
| | - Xin Sui
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China.
| | - Simei Chen
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China
| | - Bingxin Zhao
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China
| | - Zongjie Liu
- Department of Ultrasound, Hebei Medical University Third Affiliated Hospital, No.139 Ziqiang Road, Qiaoxi District, Shijiazhuang, Hebei Province, China
| | - Xiaoyan Wang
- Department of Ultrasound, Hebei General Hospital, NO.348 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, China
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Kumar A, Kempski Leadingham KM, Kerensky MJ, Sankar S, Thakor NV, Manbachi A. Visualizing tactile feedback: an overview of current technologies with a focus on ultrasound elastography. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1238129. [PMID: 37854637 PMCID: PMC10579802 DOI: 10.3389/fmedt.2023.1238129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023] Open
Abstract
Tissue elasticity remains an essential biomarker of health and is indicative of irregularities such as tumors or infection. The timely detection of such abnormalities is crucial for the prevention of disease progression and complications that arise from late-stage illnesses. However, at both the bedside and the operating table, there is a distinct lack of tactile feedback for deep-seated tissue. As surgical techniques advance toward remote or minimally invasive options to reduce infection risk and hasten healing time, surgeons lose the ability to manually palpate tissue. Furthermore, palpation of deep structures results in decreased accuracy, with the additional barrier of needing years of experience for adequate confidence of diagnoses. This review delves into the current modalities used to fulfill the clinical need of quantifying physical touch. It covers research efforts involving tactile sensing for remote or minimally invasive surgeries, as well as the potential of ultrasound elastography to further this field with non-invasive real-time imaging of the organ's biomechanical properties. Elastography monitors tissue response to acoustic or mechanical energy and reconstructs an image representative of the elastic profile in the region of interest. This intuitive visualization of tissue elasticity surpasses the tactile information provided by sensors currently used to augment or supplement manual palpation. Focusing on common ultrasound elastography modalities, we evaluate various sensing mechanisms used for measuring tactile information and describe their emerging use in clinical settings where palpation is insufficient or restricted. With the ongoing advancements in ultrasound technology, particularly the emergence of micromachined ultrasound transducers, these devices hold great potential in facilitating early detection of tissue abnormalities and providing an objective measure of patient health.
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Affiliation(s)
- Avisha Kumar
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
- HEPIUS Innovation Lab, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kelley M. Kempski Leadingham
- HEPIUS Innovation Lab, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Max J. Kerensky
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
- HEPIUS Innovation Lab, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sriramana Sankar
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nitish V. Thakor
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Amir Manbachi
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, United States
- HEPIUS Innovation Lab, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, United States
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Bodard S, Lassalle L, Larousserie F, Guinebert S, Hacquart T, Campagna R, Biau D, Regnard N, Feydy A. Performance of Sonoelastography for predicting malignancy in soft tissue. BMC Cancer 2022; 22:1305. [PMID: 36513982 DOI: 10.1186/s12885-022-10300-4] [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: 07/01/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Separating benign from malignant soft-tissue masses often requires a biopsy. The objective of this study was to assess whether shear-wave elastography (SWE) helped to separate benign from malignant soft-tissue masses. METHODS In 2015-2016, we prospectively included patients with soft-tissue masses deemed by our multidisciplinary sarcoma board to require a diagnostic biopsy. All patients underwent ultrasonography (US) followed by SWE to measure elasticity. We compared benign and malignant tumors, overall and after separating tumors with vs. without a fatty component. The biopsy findings, and surgical-specimen histology when available, served as the reference standard. RESULTS We included 136 patients, 99 with non-fatty and 37 with fatty soft-tissue masses. Mean elasticity and tumor-to-fat elasticity ratio (T/F) values were significantly lower for the benign than the malignant soft-tissue masses in the overall cohort (30.9 vs. 50.0 kilopascals (kPa), P = 0.03; and 2.55 vs. 4.30, P = 0.046) and in the non-fatty subgroup (37.8 ± 31.9 vs. 58.9 ± 39.1 kPa, P = 0.049 and 2.89 ± 5.25 vs. 5.07 ± 5.41, P = 0.046). Data for fatty tumors were non relevant due to lack of conclusive results. By receiver operating characteristics curve analysis, a T/F cutoff of 3.5 had 46% sensitivity and 84% specificity for separating benign and malignant soft-tissue masses. CONCLUSIONS SWE had good specificity and poor sensitivity for separating benign from malignant soft-tissue masses.
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Affiliation(s)
- Sylvain Bodard
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France. .,AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France. .,Université de Paris Cité, F-75006, Paris, France. .,Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, F-75006, Paris, France.
| | - Louis Lassalle
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France
| | - Frédérique Larousserie
- Université de Paris Cité, F-75006, Paris, France.,AP-HP, Hôpital Cochin, Service de Pathologie, F-75014, Paris, France
| | - Sylvain Guinebert
- AP-HP, Hôpital Necker Enfants Malades, Service d'Imagerie Adulte, F-75015, Paris, France.,Université de Paris Cité, F-75006, Paris, France
| | - Thomas Hacquart
- CHU Clermont-Fd, Service de Chirurgie orthopédique et traumatologique, F-63000, Clermont Ferrand, France
| | - Raphael Campagna
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France
| | - David Biau
- Université de Paris Cité, F-75006, Paris, France.,AP-HP, Hôpital Cochin, Service d'Orthopédie, F-75014, Paris, France
| | - Noreddine Regnard
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France
| | - Antoine Feydy
- AP-HP, Hôpital Cochin, Service de Radiologie B, F-75014, Paris, France.,Université de Paris Cité, F-75006, Paris, France
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Wu H, Wang C, An Q, Qu X, Wu X, Yan Y. Comparing the accuracy of shear wave elastography and strain elastography in the diagnosis of breast tumors: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31526. [PMID: 36343055 PMCID: PMC9646582 DOI: 10.1097/md.0000000000031526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Shear wave elastography (SWE) and strain elastography (SE) are 2 new ultrasonic technologies which have developed rapidly in recent years. Elastography transforms the elastic information of tissue into optical information for display, thus more intuitive display of tissue elasticity. Conflicting results have been obtained in different scholars' studies on the accuracy comparison of the 2 elastography technologies in the diagnosis of breast tumors. This meta-analysis aims to compare the accuracy of the 2 elastography technologies in the diagnosis of breast tumors, and provide a reference for clinical decision making. METHODS We have searched Chinese and English literatures on the accuracy of SWE and SE in the diagnosis of breast tumors from PubMed, Web of Science, China national knowledge infrastructure and Wanfang databases, and the time was up to December30, 2020. Two literature reviewers screened the literatures according to the screening criteria, and Quality Assessment of Diagnostic Accuracy Study tool was used to evaluate the quality of included literatures. Meta Disc1.4 and Stata14.0 softwares were used to perform heterogeneity test, sensitivity analysis and publication bias test. RESULTS Ten literatures included 1599 patients and 1709 breast lesions. The final results in the SWE as follow: The pooled sensitivity was 0.852 (95% confidence interval [CI] [0.826-0.874]), the pooled specificity (Spe) was 0.799 (95% CI [0.776-0.820]), the pooled positive likelihood ratio was 4.758 (95% CI [3.443-6.576]), the pooled negative likelihood ratio was 0.192 (95% CI [0.147-0.250]), the pooled diagnostic odds ratio was 29.071 (95% CI [16.967-49.811]), and the area under the summary receiver operating characteristic curve was 0.9159. The final results in the SE as follow: The pooled sensitivity was 0.843 (95% CI [0.817-0.866]), the pooled Spe was 0.766 (95% CI [0.743-0.789]), the pooled positive likelihood ratio was 4.387 (95% CI [3.088-6.233]), the pooled negative likelihood ratio was 0.216 (95% CI [0.179-0.261]), the pooled diagnostic odds ratio was 22.610 (95% CI [15.622-32.724]), and the area under the summary receiver operating characteristic curve was 0.8987. CONCLUSION The sensitivity and Spe of SWE were higher than those of SE, suggesting that SWE may have a higher accuracy in the diagnosis of breast tumors. REGISTER NAME PROSPERO. Registration number: CRD42021251110.
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Affiliation(s)
- Huayu Wu
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Wang
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qi An
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaomeng Qu
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiaohang Wu
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yumei Yan
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
- *Correspondence: Yumei Yan, Ultrasound department of the First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Xigang District, Dalian City, Liaoning Province 116011, China (e-mail: )
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Zhou Y, Wu J. Which combination of different ultrasonography modalities is more appropriate to diagnose breast cancer?: A network meta-analysis (a PRISMA-compliant article). Medicine (Baltimore) 2022; 101:e29955. [PMID: 35945707 PMCID: PMC9351919 DOI: 10.1097/md.0000000000029955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Abundant amount of literature that analyze the various detection of different ultrasound methods, no comprehensive literature that investigates the diagnostic values of breast cancer (BC) by different ultrasonography modalities through a network meta-analysis (NMA) has been made available. Each imaging diagnostic examination has its own advantages and disadvantages, and any imaging examination is not enough to make an accurate diagnosis of the disease. Thus, this study aimed to compare diagnostic values among different ultrasonography modalities, including the information of 2-dimension, stiffness and blood flow, by a network meta-analysis in the hopes of understanding which imaging methods are better and which combination of different ultrasonography modalities is more appropriate to diagnose BC. METHODS We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value(NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the 8 different ultrasound methods. RESULTS A total of 36 eligible diagnostic tests regarding 8 ultrasound methods were included in the study. According to this network meta-analysis, Breast Imaging Reporting and Data System (BI-RADS) 4b exhibited higher specificity, PPV, and accuracy and lower sensitivity and NPV than BI-RADS 4a. Contrast-enhanced ultrasound (CEUS) had the highest sensitivity, PPV, NPV and accuracy and superb microvascular imaging (SMI) had the highest specificity among color Doppler flow imaging (CDFI), power Doppler imaging(PDI), SMI and CEUS. There was no significant difference in diagnostic indexes between SMI and CEUS. Shear wave elastrography (SWE) had higher PPV and accuracy and lower sensitivity, specificity NPV than strain elastography (SE). CONCLUSION The results of this network meta-analysis suggested more appropriate combination of different ultrasound modalities is BI-RADS 4b, SMI, and SWE for the diagnosis of breast cancer.
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Affiliation(s)
- Yang Zhou
- Ultrasound department of the First Affiliated Hospital of Dalian Medical University
| | - Jialing Wu
- Ultrasound department of the First Affiliated Hospital of Dalian Medical University
- *Correspondence: Jialing Wu, No. 222 Zhongshan Road, Xigang District, Dalian City, Liaoning Province, China (e-mail: )
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Shi J, Chen L, Wang B, Zhang H, Xu L, Ye J, Liu Y, Shao Y, Sun X, Zou Y. The value of ultrasound elastography combined with multi-parameters in the diagnosis of BI-RADS4 breast lesions. Technol Health Care 2022; 30:1077-1089. [PMID: 35342064 DOI: 10.3233/thc-213272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Female breast cancer has surpassed lung cancer as the most commonly diagnosed cancer, with an estimated 2.3 million new cases (11.7%) in the global cancer statistics 2020. OBJECTIVE To evaluate the diagnostic value of ultrasound elastography combined with multi-parameters in differentiating category 4 benign and malignant lesions in the breast imaging reporting and data system (BI-RADS). METHODS This study retrospectively analyzed 206 patients (213 breast lesions) who visited the Department of Breast Surgery and underwent a breast core needle biopsy in the Department of Ultrasound in Peking University First hospital from April to December 2019. The shear wave velocity (SWV) values were collected at the following locations by virtual touch tissue imaging quantification (VTIQ): breast lesion interior, breast lesion margin, surrounding glands, and surrounding fat. Simultaneously, the strain ratio (SR) of breast lesions to glands and the area ratio (AR) of breast lesions were collected under strain elastography and a two-dimensional ultrasound mode. RESULTS Univariate analysis found that the SWV value, measured by ultrasound elastography parameters, and the AR between the elasticity and the two-dimensional ultrasound breast lesions showed statistical differences when differentiating benign and malignant lesions (p< 0.05). Binary logistic regression analysis found that the SWV values of the lesion interior and the surrounding glands were statistically significant. The joint predictors were calculated and analyzed by Receiver Operating Characteristic (ROC), and it was found that the joint predictors and the SWV values of the lesion interior have great diagnostic value. The cut-off value, sensitivity and specificity of the joint predictor and the SWV value of the lesion interior were > 3.65, 88.35% and 76.36% and > 5.55 m/s, 79.61% and 82.73%, respectively. CONCLUSIONS Ultrasound elastography combined with multi-parameters has good diagnostic value in differentiating four BI-RADS4 breast lesions.
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Affiliation(s)
- Jian Shi
- Department of Ultrasound, Peking University, First Hospital, Beijing, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University, First Hospital, Beijing, China
| | - Bin Wang
- Department of Ultrasound, Peking University, First Hospital, Beijing, China
| | - Hong Zhang
- Department of Pathology, Peking University, First Hospital, Beijing, China
| | - Ling Xu
- Breast Disease Center, Peking University, First Hospital, Beijing, China
| | - Jingming Ye
- Breast Disease Center, Peking University, First Hospital, Beijing, China
| | - Yinhua Liu
- Breast Disease Center, Peking University, First Hospital, Beijing, China
| | - Yuhong Shao
- Department of Ultrasound, Peking University, First Hospital, Beijing, China
| | - Xiuming Sun
- Department of Ultrasound, Peking University, First Hospital, Beijing, China
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University, First Hospital, Beijing, China
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Mutala TM, Mwango GN, Aywak A, Cioni D, Neri E. Determining the elastography strain ratio cut off value for differentiating benign from malignant breast lesions: systematic review and meta-analysis. Cancer Imaging 2022; 22:12. [PMID: 35151365 PMCID: PMC8841096 DOI: 10.1186/s40644-022-00447-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/10/2022] [Indexed: 12/15/2022] Open
Abstract
Background Elastography is an addition to grey-scale ultrasonic examination that has gained substantial traction within the last decade. Strain ratio (SR) has been incorporated as a semiquantitative measure within strain elastography, thus a potential imaging biomarker. The World Federation for Ultrasound in Medicine and Biology (WFUMB) published guidelines in 2015 for breast elastography. These guidelines acknowledge the marked variance in SR cut-off values used in differentiating benign from malignant lesions. The objective of this review was to include more recent evidence and seek to determine the optimal strain ratio cut off value for differentiating between benign and malignant breast lesions. Methods Comprehensive search of MEDLINE and Web of Science electronic databases with additional searches via Google Scholar and handsearching set from January 2000 to May 2020 was carried out. For retrieved studies, screening for eligibility, data extraction and analysis was done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy (PRISMA-DTA) Statement guidelines of 2018. Quality and risk of bias assessment of the studies were performed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Results A total of 424 articles, 412 from electronic database and 12 additional searches were retrieved and 65 studies were included in the narrative synthesis and subgroup analysis. The overall threshold effect indicated significant heterogeneity among the studies with Spearman correlation coefficient of Logit (TPR) vs Logit (FPR) at − 0.301, p-value = 0.015. A subgroup under machine model consisting seven studies with 783 patients and 844 lesions showed a favourable threshold, Spearman’s correlation coefficient,0.786 (p = 0.036). Conclusion From our review, currently the optimal breast SR cut-off point or value remains unresolved despite the WFUMB guidelines of 2015. Machine model as a possible contributor to cut-off value determination was suggested from this review which can be subjected to more industry and multi-center research determination. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-022-00447-5.
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Xue SS, Zhao QL, Ruan LT, Wang FQ, Zhou C, Sheng W. Comparative analysis of the quantitative parameter method and elasticity color mode method for real-time shear wave elastography in the diagnosis of benign and malignant solid breast lesions. TUMORI JOURNAL 2021; 108:578-585. [PMID: 34651522 DOI: 10.1177/03008916211048239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the performance of real-time shear wave elastography (RT-SWE) in routine clinical practice. METHODS This was a prospective study of 500 patients. The elasticity color mode method was judged by a four-mode system. The quantitative parameter method was used to measure the modulus of elasticity of the lesions. Pathologic reports were used as a gold standard to comparatively analyze the diagnostic performance of the two methods. RESULTS A total of 553 tumors were detected. The average mode value and the modulus of elasticity (Emax) of the benign breast masses was lower than that of malignant masses (p < 0.05). With Emax = 67.4 as the diagnostic threshold value, the sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of the two methods were not statistically significant different (p > 0.05). CONCLUSIONS The shear wave quantitative parameter method and the elasticity color mode method showed similar performances in the diagnosis of benign and malignant breast masses. The elasticity color mode method is convenient and intuitive, whereas the quantitative parameter method can be used to objectively assess the lesions when it is difficult to score the elasticity of an image, but could not be relied on alone.
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Affiliation(s)
- Shan-Shan Xue
- Department of Ultrasound, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Qiao-Ling Zhao
- Department of Ultrasound, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Li-Tao Ruan
- Department of Ultrasound, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Fei-Qian Wang
- Department of Ultrasound, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Can Zhou
- Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Wei Sheng
- Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China
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Altıntas Y, Bayrak M, Alabaz Ö, Celiktas M. A qualitative and quantitative assessment of simultaneous strain, shear wave, and point shear wave elastography to distinguish malignant and benign breast lesions. Acta Radiol 2021; 62:1155-1162. [PMID: 33070635 DOI: 10.1177/0284185120961422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ultrasound (US) elastography has become a routine instrument in ultrasonographic diagnosis that measures the consistency and stiffness of tissues. PURPOSE To distinguish benign and malignant breast masses using a single US system by comparing the diagnostic parameters of three kinds of breast elastography simultaneously added to B-mode ultrasonography. MATERIAL AND METHODS A total of 163 breast lesions in 159 consecutive women who underwent US-guided core needle biopsy were included in this prospective study. Before the biopsy, the lesions were examined with B-mode ultrasonography and strain (SE), shear wave (SWE), and point shear wave (STQ) elastography. The strain ratio was computed and the Tsukuba score determined. The mean elasticity values using SWE and STQ were computed and converted to Young's modulus E (kPa). RESULTS All SE, SWE, and STQ parameters showed similar diagnostic performance. The SE score, SE ratio, SWEmean, SWEmax, STQmean, and STQmax yielded higher specificity than B-mode US alone to differentiate benign and malignant masses. The sensitivity of B-mode US, SWE, and STQ was slightly higher than that of the SE score and SE ratio. The SE score, SE ratio, SWEmean, SWEmax, STQmean, and STQmax had significantly higher positive predictive value and diagnostic accuracy than B-mode US alone. The area under the curve for each of these elastography methods in differentiating benign and malignant breast lesions was 0.93, 0.93, 0.98, 0.97, 0.98, and 0.96, respectively; P<0.001 for all measurements. CONCLUSION SE (ratio and score), SWE, and STQ had higher diagnostic performance individually than B-mode US alone in distinguishing between malignant and benign breast masses.
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Affiliation(s)
| | - Mehmet Bayrak
- Department of General Surgery, Ozel Ortadogu Hospital, Adana, Turkey
| | - Ömer Alabaz
- Department of General Surgery, Cukurova University Medicine Faculty, Adana, Turkey
| | - Medih Celiktas
- Department of Radiology, Ozel Ortadogu Hospital, Adana, Turkey
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Wu M, Ren A, Xu D, Peng X, Ye X, Li A. Diagnostic Performance of Elastography in Malignant Soft Tissue Tumors: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:855-868. [PMID: 33423861 DOI: 10.1016/j.ultrasmedbio.2020.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 05/25/2023]
Abstract
Malignant soft tissue tumors (STTs) are often mistaken for benign tumors, leading to inappropriate treatment including unplanned resection. Elastography, as a non-invasive measurement of tissue mechanical properties, makes use of the different soft tissue elasticity in diverse pathologies to generate information that can be used for diagnostic purposes. Elastography for STTs carries important information that is helpful in differentiating malignant and benign masses. The present study was undertaken to systematically review existing trials on the reliability of elastography in assessment of malignant STTs. A comprehensive literature exploration of the PubMed, EMbase and China National Knowledge Infrastructure databases was conducted for published articles involving the application of elastography in distinguishing malignant STTs. The diagnostic performance of elastography was evaluated with pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and area under the summary receiver operating characteristic curve. Publication bias was also evaluated. This meta-analysis enrolled 18 eligible studies with a total of 1420 patients. The overall number of reported STTs was 1569, of which 478 were classified as positive and 1091 as negative at elastography. The pooled sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of elastography were 0.82 (95% confidence interval: 0.74-0.87), 0.80 (0.71-0.86), 3.99 (2.65-6.01) and 0.23 (0.15-0.34), respectively. The diagnostic odds ratio and area under the curve were 17.36 (8.28-36.38) and 0.88 (0.84-0.90), respectively (Glas et al. 2003). The results of meta-regression analysis revealed that the total number of patients and prevalence of malignant STTs were significant factors in sensitivity, and the year of publication, total number of patients and index test were significant factors affecting study heterogeneity for specificity (p < 0.05). No significant publication bias was observed. This meta-analysis indicates that ultrasound elastography achieves relatively good performance in discriminating between malignant and benign STTs. Nevertheless, further research is needed to verify this finding.
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Affiliation(s)
- Mengjie Wu
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Anjing Ren
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Di Xu
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaojing Peng
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinhua Ye
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ao Li
- Department of Ultrasound, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Ozturk M, Selcuk MB, Polat AV, Ozbalci AB, Baris YS. The diagnostic value of ultrasound and shear wave elastography in the differentiation of benign and malignant soft tissue tumors. Skeletal Radiol 2020; 49:1795-1805. [PMID: 32506224 DOI: 10.1007/s00256-020-03492-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
AIM To evaluate the diagnostic value of ultrasound (US) and shear wave elastography (SWE) in the differentiation of benign and malignant soft tissue tumors. MATERIALS AND METHODS A hundred and nine patients (mean age 43.3 ± 20.5, range 0-85; 64 men and 45 women) diagnosed with soft tissue tumors between August 2016 and January 2020 were evaluated with US and SWE. The stiffness of the lesions was measured as mean and maximum shear wave velocity (SWVmean and SWVmax) in meters/second (m/s). Two radiologists evaluated the US images independently and then reached a final consensus. Final diagnosis was obtained either by histopathological examination (core needle biopsy or surgery) or by follow-up. The diagnostic value of US and SWE in the differentiation of malignant and benign lesions was assessed. RESULTS Pathology results revealed 37 malignant and 43 benign lesions. Twenty-nine lesions were benign based on follow-up criteria. Consensus US reading revealed 91.9% sensitivity and 72.2% specificity with almost perfect inter-observer agreement (κ = 0.802). Larger lesion size, male gender, advanced patient age, deep location, hypoechoic and hypervascular appearance, ill-defined margins, and presence of cystic area were associated with malignant diagnosis (p < 0.001, p = 0.010, p = 0.001, p = 0.001, p = 0.003, p < 0.001, p = 0.001, and p = 0.011, respectively). Median SWVmean and median SWVmax of malignant lesions (2.87 and 2.68) were not significantly different than those of the benign lesions (3.30 and 3.05; p = 0.271 and p = 0.402, respectively). CONCLUSION US features can differentiate malignant and benign soft tissue tumors, whereas SWE did not contribute to the differentiation of soft tissue tumors.
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Affiliation(s)
- Mesut Ozturk
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey.
| | - Mustafa Bekir Selcuk
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ahmet Veysel Polat
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Aysu Basak Ozbalci
- Department of Radiology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Yakup Sancar Baris
- Department of Pathology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
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Rüger H, Psychogios G, Jering M, Zenk J. Multimodal Ultrasound Including Virtual Touch Imaging Quantification for Differentiating Cervical Lymph Nodes. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2677-2682. [PMID: 32651021 DOI: 10.1016/j.ultrasmedbio.2020.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/13/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
Defining the entity of cervical lymph nodes (LNs) is essential for the diagnosis and staging of head and neck malignancies. Virtual Touch imaging quantification (VTIQ) is a relatively new method of elastography that measures tissue stiffness quantitatively. A prospective study was conducted that included 108 patients (57 benign and 51 metastatic lymph nodes [MLNs]). Shear wave velocities (SWVs) were analyzed using VTIQ and were compared with the histopathological results. Both maximum and minimum SWVs within the LNs significantly differed between benign masses and MLNs (p < 0.001). Percentage areas of the node with SWVs >6 m/s and <3.5 m/s differed significantly (p < 0.001). Intralesional areas with SWVs ≤3.5 m/s of 0-29% (odds ratio: 93.7) and 30%-69% (odds ratio: 46.3) were predictive of malignant LNs as well as ill-defined tumor (odds ratio: 5.2). VTIQ can provide more information on the entity of cervical LNs.
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Affiliation(s)
- Holger Rüger
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany.
| | - Georgios Psychogios
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany; Department of Otorhinolaryngology, Head and Neck Surgery, University of Ioannina, Ioannina, Greece
| | - Monika Jering
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Augsburg, Augsburg, Germany
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