Quantitative Maximum Shear-Wave Stiffness of Breast Masses as a Predictor of Histopathologic Severity
| Autor: | Wendie A. Berg, Ellen B. Mendelson, David O. Cosgrove, Caroline J. Doré, Joel Gay, Jean-Pierre Henry, Claude Cohen-Bacrie |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
medicine.medical_specialty Biopsy Breast Neoplasms Severity of Illness Index Diagnosis Differential Necrosis Breast cancer Predictive Value of Tests Patient age Interquartile range medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Reference standards Breast ultrasound Aged Neoplasm Staging Aged 80 and over medicine.diagnostic_test business.industry Stiffness General Medicine Middle Aged Prognosis medicine.disease United States Europe Lymphatic Metastasis Mann–Whitney U test Elasticity Imaging Techniques Female Ultrasonography Mammary Elastography Radiology medicine.symptom business |
| Zdroj: | American Journal of Roentgenology. 205:448-455 |
| ISSN: | 1546-3141 0361-803X |
| DOI: | 10.2214/ajr.14.13448 |
| Popis: | The objective of our study was to compare quantitative maximum breast mass stiffness on shear-wave elastography (SWE) with histopathologic outcome.From September 2008 through September 2010, at 16 centers in the United States and Europe, 1647 women with a sonographically visible breast mass consented to undergo quantitative SWE in this prospective protocol; 1562 masses in 1562 women had an acceptable reference standard. The quantitative maximum stiffness (termed "Emax") on three acquisitions was recorded for each mass with the range set from 0 (very soft) to 180 kPa (very stiff). The median Emax and interquartile ranges (IQRs) were determined as a function of histopathologic diagnosis and were compared using the Mann-Whitney U test. We considered the impact of mass size on maximum stiffness by performing the same comparisons for masses 9 mm or smaller and those larger than 9 mm in diameter.The median patient age was 50 years (mean, 51.8 years; SD, 14.5 years; range, 21-94 years), and the median lesion diameter was 12 mm (mean, 14 mm; SD, 7.9 mm; range, 1-53 mm). The median Emax of the 1562 masses (32.1% malignant) was 71 kPa (mean, 90 kPa; SD, 65 kPa; IQR, 31-170 kPa). Of 502 malignancies, 23 (4.6%) ductal carcinoma in situ (DCIS) masses had a median Emax of 126 kPa (IQR, 71-180 kPa) and were less stiff than 468 invasive carcinomas (median Emax, 180 kPa [IQR, 138-180 kPa]; p = 0.002). Benign lesions were much softer than malignancies (median Emax, 43 kPa [IQR, 24-83 kPa] vs 180 kPa [IQR, 129-180 kPa]; p0.0001). Usual benign lesions were soft, including 62 cases of fibrocystic change (median Emax, 32 kPa; IQR, 24-94 kPa), 51 cases of fibrosis (median Emax, 36 kPa; IQR, 22-102 kPa), and 301 fibroadenomas (median Emax, 45 kPa; IQR, 30-79 kPa). Eight lipomas (median Emax, 14 kPa; IQR, 8-15 kPa), 154 cysts (median Emax, 29 kPa; IQR, 10-58 kPa), and seven lymph nodes (median Emax, 17 kPa; IQR, 9-40 kPa) were softer than usual benign lesions (p0.0001 for lipomas and cysts; p = 0.007 for lymph nodes). Risk lesions were slightly stiffer than usual benign lesions (p = 0.002) but tended to be softer than DCIS (p = 0.14). Fat necrosis and abscesses were relatively stiff. Conclusions were similar for both small and large masses.Despite overlap in Emax values, maximum stiffness measured by SWE is a highly effective predictor of the histopathologic severity of sonographically depicted breast masses. |
| Databáze: | OpenAIRE |
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