Which supplementary imaging modality should be used for breast ultrasonography? Comparison of the diagnostic performance of elastography and computer-aided diagnosis

PURPOSE: The aim of this study was to evaluate and compare the diagnostic performance of grayscale ultrasonography (US), US elastography, and US computer-aided diagnosis (US-CAD) in the differential diagnosis of breast masses. METHODS: A total of 193 breast masses in 175 consecutive women (mean age, 46.4 years) from June to August 2015 were included. US and elastography images were obtained and recorded. A US-CAD system was applied to the grayscale sonograms, which were automatically analyzed and visualized in order to generate a final assessment. The final assessments of breast masses were based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories, while elasticity scores were assigned using a 5-point scoring system. The diagnostic performance of grayscale US, elastography, and US-CAD was calculated and compared. RESULTS: Of the 193 breast masses, 120 (62.2%) were benign and 73 (37.8%) were malignant. Breast masses had significantly higher rates of malignancy in BI-RADS categories 4c and 5, elastography patterns 4 and 5, and when the US-CAD assessment was possibly malignant (all P<0.001). Elastography had higher specificity (40.8%, P=0.042) than grayscale US. US-CAD showed the highest specificity (67.5%), positive predictive value (PPV) (61.4%), accuracy (74.1%), and area under the curve (AUC) (0.762, all P<0.05) among the three diagnostic tools. CONCLUSION: US-CAD had higher values for specificity, PPV, accuracy, and AUC than grayscale US or elastography. Computer-based analysis based on the morphologic features of US may be very useful in improving the diagnostic performance of breast US.ope

Application of computer-aided diagnosis in breast ultrasound interpretation: improvements in diagnostic performance according to reader experience

Purpose The purpose of this study was to evaluate the usefulness of applying computer-aided diagnosis (CAD) to breast ultrasound (US), depending on the reader's experience with breast imaging. Methods Between October 2015 and January 2016, two experienced readers obtained and analyzed the grayscale US images of 200 cases according to the Breast Imaging Reporting and Data System (BI-RADS) lexicon and categories. They additionally applied CAD (S-Detect) to analyze the lesions and made a diagnostic decision subjectively, based on grayscale US with CAD. For the same cases, two inexperienced readers analyzed the grayscale US images using the BI-RADS lexicon and categories, added CAD, and came to a subjective diagnostic conclusion. We then compared the diagnostic performance depending on the reader's experience with breast imaging. Results The sensitivity values for the experienced readers, inexperienced readers, and CAD (for experienced and inexperienced readers) were 91.7%, 75.0%, 75.0%, and 66.7%, respectively. The specificity values for the experienced readers, inexperienced readers, and CAD (for experienced and inexperienced readers) were 76.6%, 71.8%, 78.2%, and 76.1%, respectively. When diagnoses were made subjectively in combination with CAD, the specificity significantly improved (76.6% to 80.3%) without a change in the sensitivity (91.7%) in the experienced readers. After subjective combination with CAD, both of the sensitivity and specificity improved in the inexperienced readers (75.0% to 83.3% and 71.8% to 77.1%). In addition, the area under the curve improved for both the experienced and inexperienced readers (0.84 to 0.86 and 0.73 to 0.80) after the addition of CAD. Conclusion CAD is more useful for less experienced readers. Combining CAD with breast US led to improved specificity for both experienced and inexperienced readers

Which supplementary imaging modality should be used for breast ultrasonography? Comparison of the diagnostic performance of elastography and computer-aided diagnosis

Purpose The aim of this study was to evaluate and compare the diagnostic performance of grayscale ultrasonography (US), US elastography, and US computer-aided diagnosis (US-CAD) in the differential diagnosis of breast masses. Methods A total of 193 breast masses in 175 consecutive women (mean age, 46.4 years) from June to August 2015 were included. US and elastography images were obtained and recorded. A US-CAD system was applied to the grayscale sonograms, which were automatically analyzed and visualized in order to generate a final assessment. The final assessments of breast masses were based on the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) categories, while elasticity scores were assigned using a 5-point scoring system. The diagnostic performance of grayscale US, elastography, and US-CAD was calculated and compared. Results Of the 193 breast masses, 120 (62.2%) were benign and 73 (37.8%) were malignant. Breast masses had significantly higher rates of malignancy in BI-RADS categories 4c and 5, elastography patterns 4 and 5, and when the US-CAD assessment was possibly malignant (all P<0.001). Elastography had higher specificity (40.8%, P=0.042) than grayscale US. US-CAD showed the highest specificity (67.5%), positive predictive value (PPV) (61.4%), accuracy (74.1%), and area under the curve (AUC) (0.762, all P<0.05) among the three diagnostic tools. Conclusion US-CAD had higher values for specificity, PPV, accuracy, and AUC than grayscale US or elastography. Computer-based analysis based on the morphologic features of US may be very useful in improving the diagnostic performance of breast US

Η αξιολόγηση της υποβοηθούμενης με αναρρόφηση βιοψίας στη μελέτη των μικροαποτιτανώσεων του μαστού

Οι μικροαποτιτανώσεις του μαστού είναι μικροσκοπικές (&lt;1mm) εναποθέσεις αλάτων ασβεστίου στο μαζικό παρέγχυμα και αποτελούν μαστογραφικό εύρημα. Οι μικροαποτιτανώσεις είναι συνήθως καλοήθεις, αλλά είναι δυνατόν να αποτελούν το μόνο εύρημα ενός αρχόμενου καρκινώματος του μαστού. Η αξιολόγηση των μικροαποτιτανώσεων βασίζεται στο σύστημα BIRADS ( Breast Imaging Reporting and Data System) του Αμερικάνικου Κολλεγίου Ακτινολογίας και ταξινομεί τις μικροαποτιτανώσεις της μαστογραφίας σε 6 κατηγορίες ανάλογα με τη μορφολογία και τη κατανομή τους. Οι κατηγορίες 3, 4a, 4b και 4c έχουν αναλογικά αυξανόμενες πιθανότητες κακοήθειας, ενώ η κατηγορία 5 θεωρείται αντίστοιχη κακοήθειας και συνεπώς έχουν ανάγκη βιοψίας. Η κλασσική προσέγγιση για τη βιοψία των μικροαποτιτανώσεων είναι με την τοποθέτηση αγκίστρου με συρμάτινο οδηγό (hook wire localization) από τους ακτινολόγους και εν συνεχεία η χειρουργική εξαίρεση της σημανθείσας περιοχής. Τα τελευταία χρόνια, η στερεοτακτική με αναρρόφηση βιοψία του μαστού έχει εισέλθει με αυξανόμενη δυναμική στη διερεύνηση των μη ψηλαφητών βλαβών του μαστού, όπως είναι οι μικροαποτιτανώσεις. Η αξιολόγηση αυτής της διαγνωστικής προσέγγισης αποτελεί και το στόχο της παρούσας μελέτης. Στη Μονάδα Μαστού του Ιπποκράτειου Νοσοκομείου Αθηνών, από τον Ιανουάριο του 2005 μέχρι το Νοέμβριο του 2011, αντιμετωπίστηκαν 853 γυναίκες ασθενείς με μαστογραφικά ευρήματα ύποπτων μικροαποτιτανώσεων, κατηγοριών BIRADS 3, 4a, 4b, 4c και 5 . Αναλύθηκαν τα αποτελέσματα της στερεοτακτικής με αναρρόφηση βιοψίας του μαστού με τη χρήση του Μαμμοτόμου. Αποτελέσματα: Η ιστολογική εξέταση των δειγμάτων που λήφθηκαν με τη χρήση της στερεοτακτικής βιοψίας υπό αναρρόφηση ανέδειξε 594 καλοήθεις (69.6%), 66 βλάβες υψηλού κινδύνου (7.7%) και 164 κακοήθεις (19.2%) βλάβες. Είκοσι εννιά περιπτώσεις κατηγοριοποιήθηκαν ως μη διαγνωστικές, καθώς ένα περιστατικό (0,1%) το δείγμα κρίθηκε ακατάλληλο για ιστολογική εξέταση λόγω μηχανικών αλλοιώσεων και 28 (3,3%) περιπτώσεις, λόγω επιφανειακής εντόπισης των μικροαποτιτανώσεων, παραπέμφθηκαν για ανοικτή χειρουργική βιοψία. Ο συνολικός βαθμός υποεκτίμησης ήταν 4.6% και τα ψευδώς αρνητικά αποτελέσματα ανήλθαν σε 2.4%. Η ευαισθησία της μεθόδου έφθασε το 98.2%, η ειδικότητα ήταν 100%, η θετική προγνωστική αξία ήταν 100% και η αρνητική προγνωστική αξία έφτασε το 97.6%. Συμπέρασμα: Η στερεοτακτική με αναρρόφηση βιοψία του μαστού είναι μια ασφαλής και αξιόπιστη μέθοδος για την αξιολόγηση των ύποπτων μικροαποτιτανώσεων του μαστού και για τη διάγνωση του καρκίνου του μαστού σε πρώιμο στάδιο.Purpose: Vacuum Assisted Breast Biopsy (VABB) is a minimal invasive technique, in the diagnostic approach for non palpable lesions. The aim of this study was to evaluate the efficacy and accuracy of VABB in the investigation of breast microcalcifications, a significant mammographic sign of early breast cancer. The rate of histological underestimation and the false negative rate were assessed based on the follow up data and the histological examination of the surgical specimens. Methods: From January 2005 to November 2011, 853 women with mammographically detected microcalcifications, classified as BI-RADS 3-5, were referred to our Breast Unit for evaluation. During this 6-year period, 825 vacuum-assisted breast biopsies were performed, while 28 women (3.3%) were not submitted to VABB due to superficial location of microcalcifications. Results: VABB histology revealed 594 benign (69.6%), 66 high risk (7.7%) and 164 malignant (19.2%) lesions. Twenty-nine cases were classified as non diagnostic, as in one case (0.1%) the sample of the biopsy was maladjusted and not suitable to undergo histopathological examination due to mechanical alterations and in 28 (3,3%) cases microcalcifications were located in proximity to the skin and open surgical excision was performed. The overall documented underestimation rate was 4.6%, the false negative rate was 2.4%. The sensitivity of the method was 98.2%, specificity 100%, positive predictive value 100% and negative predictive value 97.6%. Conclusions: VABB is a safe and accurate method for the evaluation of suspicious microcalcifications and diagnosis of early breast cancer