Imaging Features of Triple N Negative Breast Cancers – Mammography, Ultrasound and Magnetic Resonance Imaging

Breast cancer (BC) is a highly heterogeneous disease. Aim was to evaluate imaging features of triple negative breast cancers (TNBC) in comparison to non-TNBC. We reviewed data of 30 patients who had been diagnosed as having TNBC and 37 patients with non-TNBC (control group) using criteria described for mammography (MMG), ultrasound (US) and magnetic resonance imaging (MRI) in Breast Imaging-Reporting and Data System (BI-RADS) lexicon for image interpretation. Age of patients, size of tumor, multifocality, histological type, tumor grade and status of lymph nodes were reviewed. TNBC were more often histological grade 3 and had significantly more positive lymph nodes at the time of diagnosis on pathology reports. On MMG, US and MRI TNBC mostly appeared as regularly shaped masses. On US as hypoechogenic masses with no posterior acoustic features and on MRI as masses with rim type of enhancement, fast wash-in and plateau type of curves. Most frequent category reported after MMG and US was BI RADS 4, and after MRI BI RADS 5. In conclusion, our study confirmed higher histological grade of TNBC, as well as more frequent lymph node involvement in comparation to the non-TNBC. TNBC showed tendency to affect younger women and to be larger than non-TNBC. Although, they most often presented as a mass on mammography and sonography, in a significant number of cases they remained miscategorized, due to the benign imaging features. All cases are recognized on MRI where they appear as rim enhancing masses

Elastographic values of breast tissue in women

Uvod: Elastografija je nova UZV metoda koja se do sada upotrebljavala za lakšu BIRADS kategorizaciju sumnjivih lezija. Svrha našeg rada je bila procijeniti elastografsku tvrdoću normalnog tkiva dojke, njenu povezanost s mamografski i ultrazvučno procijenjenom gustoćom tkiva dojke te odrediti povezanost s faktorima rizika za karcinom dojke te faktorima koji utječu na mamografsku tvrdoću. Materijali i metode: Proveli smo prospektivno istraživanje u koje smo uključili 200 žena različite dobi. Sve žene su ispunile upitnik s pitanjima o osobnoj, obiteljskoj i reproduktivnoj anamnezi. 100 žena je imalo priložene mamografske slike za usporedbu te su bile podijeljene u 4 skupine prema mamografskoj gustoći tkiva. Svim ženama se učinio UZV pregled u B-modu i elastografija u živom vremenu. Svakoj ženi se dodijelila i UZV skupina prema gustoći tkiva. U svakom kvadrantu dojke izmjerila se tvrdoća žljezdanog parenhima i masnog tkiva. Zatim smo izračunali prosječne elastografske vrijednosti tkiva dojke, usporedili ih s MMG i UZV procijenjenom gustoćom tkiva te s određenim kliničko-anamnestičkim parametrima. Rezultati: Elastografske vrijednosti žljezdanog tkiva (66,4 kPa) su veće od elastografskih vrijednosti masnog tkiva (26,1 kPa) u svim kvadrantima i u obje dojke. Najniže elastografske vrijednosti su izmjerene u DLK, dok su vrijednosti lijeve dojke značajno veće u odnosu na desnu. Elastografske vrijednosti žljezdanog tkiva pozitivno koreliraju s mastalgijom i brojem nađenih benignih promjena u dojkama, a negativno s dobi, brojem trudnoća i BMI. Elastografske vrijednosti masnog tkiva negativno koreliraju s dobi i indeksom tjelesne mase. Elastografske vrijednosti žljezdanog i masnog tkiva pozitivno koreliraju s mamografskim i ultrazvučnim skupina prema gustoći tkiva. Zaključci: Naše istraživanje je pokazalo povezanost tvrdoće tkiva dojke i njezine gustoće, to znači kako je žene moguće svrstati u skupinu onih s višim ili nižim rizikom za dobivanje karcinoma dojke metodom koja je brza, jeftina i bez ionizirajućeg zračenja. Ova bi studija mogla pridonijeti proširivanju indikacija za upotrebu elastografije u kliničkoj praksi.Introduction: Breast elastography is a new ultrasound method for easier BIRADS categorization of the suspect lesions. Aim of this study is to estimate the elasticity of normal breast tissue and to compare it to the estimated mammographic and ultrasound breast density, also to correlate it with some well-known breast cancer risk factors and factors that influence on mammographic density. Materials and methods: A prospective study with 200 women of different age was performed. All women fulfilled questionary about personal, familiar and reproductive history. A hundred women that had attached mammographic images were placed in one of four groups according to estimated mammographic density. The next step was an ultrasound examination with B-mod and elastography. One of three groups according to ultrasound density was assigned to all women. Elasticity of breast parenchyma and fatty tissue in all breast quadrants was measured. Average elastographic values of breast tissue were calculated and compared to estimated mammographic and ultrasound density, also to personal history factors. Results: Elasticity of normal breast parenchyma (66,4 kPa) was higher than fatty tissue (26,1 kPa) in all breast quadrants and in both breasts. Lower outer quadrant of breasts had the lowest elasticity values of both parenchyma and fat. A left breast had higher elasticity values of breast tissue, comparing to a right breast. Glandular elasticity positively correlates with mastalgia and number of benign breast lesions. It negatively correlates with age, number of pregnancies and body mass index (BMI). Fat tissue elasticity negatively correlates with age and BMI. Glandular and fat tissue elasticity positively correlates with mammographic and ultrasound estimated breast density. Conclusions: There is good correlation between breast elasticity and breast density. It means that the women could be classified in one of the groups with lower or higher breast cancer risk without ionizing radiation, also with the method which is fast and cheap. This study could contribute to widen indications for elastography in routine clinical practice

Elastografske vrijednosti tkiva dojke u žena [Elastographic values of breast tissue in women]

Introduction: Breast elastography is a new ultrasound method for easier BIRADS categorization of the suspect lesions. Aim of this study is to estimate the elasticity of normal breast tissue and to compare it to the estimated mammographic and ultrasound breast density, also to correlate it with some well-known breast cancer risk factors and factors that influence on mammographic density. Materials and methods: A prospective study with 200 women of different age was performed. All women fulfilled questionary about personal, familiar and reproductive history. A hundred women that had attached mammographic images were placed in one of four groups according to estimated mammographic density. The next step was an ultrasound examination with B-mod and elastography. One of three groups according to ultrasound density was assigned to all women. Elasticity of breast parenchyma and fatty tissue in all breast quadrants was measured. Average elastographic values of breast tissue were calculated and compared to estimated mammographic and ultrasound density, also to personal history factors. Results: Elasticity of normal breast parenchyma (66,4 kPa) was higher than fatty tissue (26,1 kPa) in all breast quadrants and in both breasts. Lower outer quadrant of breasts had the lowest elasticity values of both parenchyma and fat. A left breast had higher elasticity values of breast tissue, comparing to a right breast. Glandular elasticity positively correlates with mastalgia and number of benign breast lesions. It negatively correlates with age, number of pregnancies and body mass index (BMI). Fat tissue elasticity negatively correlates with age and BMI. Glandular and fat tissue elasticity positively correlates with mammographic and ultrasound estimated breast density. Conclusions: There is good correlation between breast elasticity and breast density. It means that the women could be classified in one of the groups with lower or higher breast cancer risk without ionizing radiation, also with the method which is fast and cheap. This study could contribute to widen indications for elastography in routine clinical practice

Elastographic values of breast tissue in women

Uvod: Elastografija je nova UZV metoda koja se do sada upotrebljavala za lakšu BIRADS kategorizaciju sumnjivih lezija. Svrha našeg rada je bila procijeniti elastografsku tvrdoću normalnog tkiva dojke, njenu povezanost s mamografski i ultrazvučno procijenjenom gustoćom tkiva dojke te odrediti povezanost s faktorima rizika za karcinom dojke te faktorima koji utječu na mamografsku tvrdoću. Materijali i metode: Proveli smo prospektivno istraživanje u koje smo uključili 200 žena različite dobi. Sve žene su ispunile upitnik s pitanjima o osobnoj, obiteljskoj i reproduktivnoj anamnezi. 100 žena je imalo priložene mamografske slike za usporedbu te su bile podijeljene u 4 skupine prema mamografskoj gustoći tkiva. Svim ženama se učinio UZV pregled u B-modu i elastografija u živom vremenu. Svakoj ženi se dodijelila i UZV skupina prema gustoći tkiva. U svakom kvadrantu dojke izmjerila se tvrdoća žljezdanog parenhima i masnog tkiva. Zatim smo izračunali prosječne elastografske vrijednosti tkiva dojke, usporedili ih s MMG i UZV procijenjenom gustoćom tkiva te s određenim kliničko-anamnestičkim parametrima. Rezultati: Elastografske vrijednosti žljezdanog tkiva (66,4 kPa) su veće od elastografskih vrijednosti masnog tkiva (26,1 kPa) u svim kvadrantima i u obje dojke. Najniže elastografske vrijednosti su izmjerene u DLK, dok su vrijednosti lijeve dojke značajno veće u odnosu na desnu. Elastografske vrijednosti žljezdanog tkiva pozitivno koreliraju s mastalgijom i brojem nađenih benignih promjena u dojkama, a negativno s dobi, brojem trudnoća i BMI. Elastografske vrijednosti masnog tkiva negativno koreliraju s dobi i indeksom tjelesne mase. Elastografske vrijednosti žljezdanog i masnog tkiva pozitivno koreliraju s mamografskim i ultrazvučnim skupina prema gustoći tkiva. Zaključci: Naše istraživanje je pokazalo povezanost tvrdoće tkiva dojke i njezine gustoće, to znači kako je žene moguće svrstati u skupinu onih s višim ili nižim rizikom za dobivanje karcinoma dojke metodom koja je brza, jeftina i bez ionizirajućeg zračenja. Ova bi studija mogla pridonijeti proširivanju indikacija za upotrebu elastografije u kliničkoj praksi.Introduction: Breast elastography is a new ultrasound method for easier BIRADS categorization of the suspect lesions. Aim of this study is to estimate the elasticity of normal breast tissue and to compare it to the estimated mammographic and ultrasound breast density, also to correlate it with some well-known breast cancer risk factors and factors that influence on mammographic density. Materials and methods: A prospective study with 200 women of different age was performed. All women fulfilled questionary about personal, familiar and reproductive history. A hundred women that had attached mammographic images were placed in one of four groups according to estimated mammographic density. The next step was an ultrasound examination with B-mod and elastography. One of three groups according to ultrasound density was assigned to all women. Elasticity of breast parenchyma and fatty tissue in all breast quadrants was measured. Average elastographic values of breast tissue were calculated and compared to estimated mammographic and ultrasound density, also to personal history factors. Results: Elasticity of normal breast parenchyma (66,4 kPa) was higher than fatty tissue (26,1 kPa) in all breast quadrants and in both breasts. Lower outer quadrant of breasts had the lowest elasticity values of both parenchyma and fat. A left breast had higher elasticity values of breast tissue, comparing to a right breast. Glandular elasticity positively correlates with mastalgia and number of benign breast lesions. It negatively correlates with age, number of pregnancies and body mass index (BMI). Fat tissue elasticity negatively correlates with age and BMI. Glandular and fat tissue elasticity positively correlates with mammographic and ultrasound estimated breast density. Conclusions: There is good correlation between breast elasticity and breast density. It means that the women could be classified in one of the groups with lower or higher breast cancer risk without ionizing radiation, also with the method which is fast and cheap. This study could contribute to widen indications for elastography in routine clinical practice

Elastographic values of breast tissue in women

Uvod: Elastografija je nova UZV metoda koja se do sada upotrebljavala za lakšu BIRADS kategorizaciju sumnjivih lezija. Svrha našeg rada je bila procijeniti elastografsku tvrdoću normalnog tkiva dojke, njenu povezanost s mamografski i ultrazvučno procijenjenom gustoćom tkiva dojke te odrediti povezanost s faktorima rizika za karcinom dojke te faktorima koji utječu na mamografsku tvrdoću. Materijali i metode: Proveli smo prospektivno istraživanje u koje smo uključili 200 žena različite dobi. Sve žene su ispunile upitnik s pitanjima o osobnoj, obiteljskoj i reproduktivnoj anamnezi. 100 žena je imalo priložene mamografske slike za usporedbu te su bile podijeljene u 4 skupine prema mamografskoj gustoći tkiva. Svim ženama se učinio UZV pregled u B-modu i elastografija u živom vremenu. Svakoj ženi se dodijelila i UZV skupina prema gustoći tkiva. U svakom kvadrantu dojke izmjerila se tvrdoća žljezdanog parenhima i masnog tkiva. Zatim smo izračunali prosječne elastografske vrijednosti tkiva dojke, usporedili ih s MMG i UZV procijenjenom gustoćom tkiva te s određenim kliničko-anamnestičkim parametrima. Rezultati: Elastografske vrijednosti žljezdanog tkiva (66,4 kPa) su veće od elastografskih vrijednosti masnog tkiva (26,1 kPa) u svim kvadrantima i u obje dojke. Najniže elastografske vrijednosti su izmjerene u DLK, dok su vrijednosti lijeve dojke značajno veće u odnosu na desnu. Elastografske vrijednosti žljezdanog tkiva pozitivno koreliraju s mastalgijom i brojem nađenih benignih promjena u dojkama, a negativno s dobi, brojem trudnoća i BMI. Elastografske vrijednosti masnog tkiva negativno koreliraju s dobi i indeksom tjelesne mase. Elastografske vrijednosti žljezdanog i masnog tkiva pozitivno koreliraju s mamografskim i ultrazvučnim skupina prema gustoći tkiva. Zaključci: Naše istraživanje je pokazalo povezanost tvrdoće tkiva dojke i njezine gustoće, to znači kako je žene moguće svrstati u skupinu onih s višim ili nižim rizikom za dobivanje karcinoma dojke metodom koja je brza, jeftina i bez ionizirajućeg zračenja. Ova bi studija mogla pridonijeti proširivanju indikacija za upotrebu elastografije u kliničkoj praksi.Introduction: Breast elastography is a new ultrasound method for easier BIRADS categorization of the suspect lesions. Aim of this study is to estimate the elasticity of normal breast tissue and to compare it to the estimated mammographic and ultrasound breast density, also to correlate it with some well-known breast cancer risk factors and factors that influence on mammographic density. Materials and methods: A prospective study with 200 women of different age was performed. All women fulfilled questionary about personal, familiar and reproductive history. A hundred women that had attached mammographic images were placed in one of four groups according to estimated mammographic density. The next step was an ultrasound examination with B-mod and elastography. One of three groups according to ultrasound density was assigned to all women. Elasticity of breast parenchyma and fatty tissue in all breast quadrants was measured. Average elastographic values of breast tissue were calculated and compared to estimated mammographic and ultrasound density, also to personal history factors. Results: Elasticity of normal breast parenchyma (66,4 kPa) was higher than fatty tissue (26,1 kPa) in all breast quadrants and in both breasts. Lower outer quadrant of breasts had the lowest elasticity values of both parenchyma and fat. A left breast had higher elasticity values of breast tissue, comparing to a right breast. Glandular elasticity positively correlates with mastalgia and number of benign breast lesions. It negatively correlates with age, number of pregnancies and body mass index (BMI). Fat tissue elasticity negatively correlates with age and BMI. Glandular and fat tissue elasticity positively correlates with mammographic and ultrasound estimated breast density. Conclusions: There is good correlation between breast elasticity and breast density. It means that the women could be classified in one of the groups with lower or higher breast cancer risk without ionizing radiation, also with the method which is fast and cheap. This study could contribute to widen indications for elastography in routine clinical practice

Comparison of sonoelastographic values of breast tissue with mammographically and ultrasonically assessed density: a cross-sectional study

Aim: To determine the relationship between breast stiffness assessed with sonoelastography (elasticity) and breast tissue density assessed with mammography (MG) and ultrasound (US). ----- Methods: This cross-sectional study involved 100 women who underwent MG, gray-scale US, and shear-wave sonoelastography during 2013. Mammographic density was categorized into four groups and sonographic density into three groups according to Breast Imaging-Reporting and Data System criteria. The stiffness of breast parenchymal and adipose tissue in all breast quadrants was quantified by shear-wave sonoelastography. Mean elastographic estimates were compared with MG- and US-derived density estimates. ----- Results: Parenchymal and adipose tissue elasticity positively correlated with MG- and US-derived breast density (for parenchyma: for MG Kendall's tau b 0.522; Jonckheere-Terpstra test P<0.001 and for US Kendall's tau b 0.533; Jonckheere-Terpstra test P<0.001); the higher was the breast density on MG and US, the higher was the elastographic stiffness. ----- Conclusion: Sonoelastographic breast stiffness strongly positively correlated with breast density. Thus, sonoelastography may have a potential for estimating the breast cancer risk, which allows a novel application of this technique in routine clinical practice

Acute aortic occlusion

Cilj: Cilj ovog rada je prikazati akutnu aortalnu okluziju, stanje hitnoće, često nazivano i „vaskularnom katastrofom” zbog toga što nosi lošu prognozu. To je stanje dijagnostički izazov jer zahtijeva rano prepoznavanje i hitno liječenje. Prikazat ćemo dva slučaja akutne aortalne okluzije. Prikaz slučaja: U oba slučaja bolesnici su se javili u hitnu službu Kliničke bolnice Dubrava; radilo se o ženama između 55 i 65 godina, kojima se nakon prethodne bolesti pogoršalo stanje u smislu bola u obje noge. Jedna je bolesnica imala i osjećaj slabosti u obje noge te neurološke ispade na prijemu, dok su se kod druge bolesnice našli samo znaci arterijske insuficijencije (hladni ekstremiteti i odsutnost pulsa). U prvom slučaju učinili smo pregled doplerom dupleksom koji je pokazao niske brzine protoka u obje arterije femoralis superficialis s PSV-om (engl. peak systolic velocity) manjim od 5 cm/sek te izmijenjene spektre, što u prvom redu upućuje na proksimalnu patologiju. Višeslojna kompjutorizirana tomografija (engl. multi-slice computerised tomography; MSCT) angiografija abdominalne aorte pokazala je trombotske mase abdominalne aorte u infrarenalnom dijelu, koje u potpunosti ispunjavaju lumen. Učinjena je trombektomija infrarenalne aorte. U drugom slučaju odmah smo pristupili MSCT angiografiji abdominalne aorte prema standardnom protokolu u hitnoj službi, koji pokaže potpunu okluziju aorte iznad bifurkacije uz prisutnu okluziju obje ilijačne arterije. Učinjena je Fogartyjeva embolektomija. Rasprava i zaključak: Radi se o rijetkom stanju koje je lako previdjeti, premda se karakteristično očituje. Pravilno postavljena indikacija za slikovne metode i njihovo izvođenje od krucijalne je važnosti za dijagnozu stanja koje se liječi kirurški te nosi visok mortalitet.Aim: Aim of this article is to present acute aortic occlusion as an emergent vascular event, often called ”vascular catastrophe” because of its poor prognosis. It is a diagnostic challenge because it requires early recognition and urgent intervention. We will present two cases of acute aortic occlusion. Case report: In both cases, patients referred to the Emergency Department of the Clinical Hospital Dubrava. Both patients were female, from 55 to 65 years, who presented pain in both legs as deterioration in their condition. One patient had weakness in both legs and neurological symptoms, and the other one had only signs of arterial insufficiency (cold extremities and absence of pulse). In the first case we started with duplex doppler examination, which showed low flow velocities in both superficial femoral arteries with peak systolic velocity lower than 5cm/sec and changed spectra indicating proximal pathology. Multi-slice computerized tomography (MSCT) angiography of abdominal aorta showed thrombosis in infrarenal part of the abdominal aorta which completely filled the lumen. Thrombectomy of the infrarenal aorta was performed. In the second case, we immediately performed MSCT angiography of abdominal aorta by standard protocol in emergency department, which showed complete occlusion of the aorta above the bifurcation and occlusion of both common iliac arteries. Fogarty embolectomy was performed. Discussion and conclusion: Acute aortic occlusion is a rare condition which is easy to overlook, but has a characteristic presentation. A proper indication for imaging methods is of crucial importance for diagnosis of this condition which is treated with surgical methods and has a high mortality

Acute aortic occlusion

Cilj: Cilj ovog rada je prikazati akutnu aortalnu okluziju, stanje hitnoće, često nazivano i „vaskularnom katastrofom” zbog toga što nosi lošu prognozu. To je stanje dijagnostički izazov jer zahtijeva rano prepoznavanje i hitno liječenje. Prikazat ćemo dva slučaja akutne aortalne okluzije. Prikaz slučaja: U oba slučaja bolesnici su se javili u hitnu službu Kliničke bolnice Dubrava; radilo se o ženama između 55 i 65 godina, kojima se nakon prethodne bolesti pogoršalo stanje u smislu bola u obje noge. Jedna je bolesnica imala i osjećaj slabosti u obje noge te neurološke ispade na prijemu, dok su se kod druge bolesnice našli samo znaci arterijske insuficijencije (hladni ekstremiteti i odsutnost pulsa). U prvom slučaju učinili smo pregled doplerom dupleksom koji je pokazao niske brzine protoka u obje arterije femoralis superficialis s PSV-om (engl. peak systolic velocity) manjim od 5 cm/sek te izmijenjene spektre, što u prvom redu upućuje na proksimalnu patologiju. Višeslojna kompjutorizirana tomografija (engl. multi-slice computerised tomography; MSCT) angiografija abdominalne aorte pokazala je trombotske mase abdominalne aorte u infrarenalnom dijelu, koje u potpunosti ispunjavaju lumen. Učinjena je trombektomija infrarenalne aorte. U drugom slučaju odmah smo pristupili MSCT angiografiji abdominalne aorte prema standardnom protokolu u hitnoj službi, koji pokaže potpunu okluziju aorte iznad bifurkacije uz prisutnu okluziju obje ilijačne arterije. Učinjena je Fogartyjeva embolektomija. Rasprava i zaključak: Radi se o rijetkom stanju koje je lako previdjeti, premda se karakteristično očituje. Pravilno postavljena indikacija za slikovne metode i njihovo izvođenje od krucijalne je važnosti za dijagnozu stanja koje se liječi kirurški te nosi visok mortalitet.Aim: Aim of this article is to present acute aortic occlusion as an emergent vascular event, often called ”vascular catastrophe” because of its poor prognosis. It is a diagnostic challenge because it requires early recognition and urgent intervention. We will present two cases of acute aortic occlusion. Case report: In both cases, patients referred to the Emergency Department of the Clinical Hospital Dubrava. Both patients were female, from 55 to 65 years, who presented pain in both legs as deterioration in their condition. One patient had weakness in both legs and neurological symptoms, and the other one had only signs of arterial insufficiency (cold extremities and absence of pulse). In the first case we started with duplex doppler examination, which showed low flow velocities in both superficial femoral arteries with peak systolic velocity lower than 5cm/sec and changed spectra indicating proximal pathology. Multi-slice computerized tomography (MSCT) angiography of abdominal aorta showed thrombosis in infrarenal part of the abdominal aorta which completely filled the lumen. Thrombectomy of the infrarenal aorta was performed. In the second case, we immediately performed MSCT angiography of abdominal aorta by standard protocol in emergency department, which showed complete occlusion of the aorta above the bifurcation and occlusion of both common iliac arteries. Fogarty embolectomy was performed. Discussion and conclusion: Acute aortic occlusion is a rare condition which is easy to overlook, but has a characteristic presentation. A proper indication for imaging methods is of crucial importance for diagnosis of this condition which is treated with surgical methods and has a high mortality

Exploring Association of Breast Pain, Pregnancy, and Body Mass Index with Breast Tissue Elasticity in Healthy Women: Glandular and Fat Differences

Breast sonoelastography is a relatively novel ultrasound (US) method that enables estimation of tissue stiffness to estimate the elasticity of normal breast tissue and seek to correlate it with well-known breast cancer risk factors. Two hundred women of different age were included in the study and completed a questionnaire about personal, familiar, and reproductive history. Glandular and fatty tissue elasticity in all breast quadrants was measured by shear wave elastography (SWE). Mean elastographic values of breast tissue were calculated and compared to personal history risk factors. Elasticity of normal glandular tissue (66.4 kilopascals (kPa)) was higher than fatty tissue (26.1 kPa) in all breast quadrants and in both breasts. Lower outer quadrant (LOQ) had the lowest elasticity values of both parenchyma and fat. Higher elasticity values of breast tissue were confirmed in the left breast than in the right breast. Glandular and fat tissue elasticity negatively correlated with body mass index (BMI). Women with mastodynia had higher glandular elastographic values compared to subjects without breast pain. Nuliparity was also associated with higher elasticity of glandular breast tissue. The results of this study are promising and could, over time, contribute to a better understanding of glandular breast tissue elasticity as a potential risk factor for breast cancer

Elastic Modulus and Elasticity Ratio of Malignant Breast Lesions with Shear Wave Ultrasound Elastography: Variations with Different Region of Interest and Lesion Size

Shear wave elastography (SWE) is a type of ultrasound elastography with which the elastic properties of breast tissues can be quantitatively assessed. The purpose of this study was to determine the impact of different regions of interest (ROI) and lesion size on the performance of SWE in differentiating malignant breast lesions. The study included 150 female patients with histopathologically confirmed malignant breast lesions. Minimal (Emin), mean (Emean), maximal (Emax) elastic modulus and elasticity ratio (e-ratio) values were measured using a circular ROI size of 2, 4 and 6 mm diameters and the lesions were divided into large (diameter ≥ 15 mm) and small (diameter < 15 mm). Highest Emin, Emean and e-ratio values and lowest variability were observed when using the 2 mm ROI. Emax values did not differ between different ROI sizes. Larger lesions had significantly higher Emean and Emax values, but there was no difference in e-ratio values between lesions of different sizes. In conclusion, when measuring the Emin, Emean and e-ratio of malignant breast lesions using SWE the smallest possible ROI size should be used regardless of lesion size. ROI size has no impact on Emax values while lesion size has no impact on e-ratio values