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Yan J, Fang S. Diagnostic performance of ultrasound elastography in differentiating malignant from benign breast microcalcifications: a case-control study. BMC Med Imaging 2025; 25:134. [PMID: 40275172 PMCID: PMC12023353 DOI: 10.1186/s12880-025-01638-9] [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: 12/24/2024] [Accepted: 03/17/2025] [Indexed: 04/26/2025] Open
Abstract
OBJECTIVE To evaluate the sensitivity and specificity of ultrasound elastography in differentiating between malignant and benign breast microcalcifications through a case-control study. METHODS A total of 300 female patients were enrolled in this study, equally divided between malignant (n = 150) and benign (n = 150) microcalcification groups. The malignant cases were histologically confirmed as ductal carcinoma in situ or invasive breast cancer, while benign cases were confirmed through histology or follow-up as fibroadenoma, fibrocystic changes, or benign calcifications. Ultrasound elastography parameters, including elastic modulus (kPa), strain ratio, and elasticity scores, were measured and compared between groups. Multiple logistic regression analysis was performed to identify independent predictors, and diagnostic performance was evaluated using ROC curve analysis. RESULTS Malignant lesions demonstrated significantly higher mean elasticity values compared to benign lesions (88.3 ± 16.2 kPa vs. 45.7 ± 9.8 kPa, P < 0.001). The strain ratio and elasticity scores were also significantly elevated in the malignant group (both P < 0.001). Multivariate analysis identified elastic modulus (OR = 1.09, 95%CI: 1.06-1.12, P < 0.001) and strain ratio (OR = 2.50, 95%CI: 1.70-3.80, P < 0.001) as independent predictors of malignancy. Using an optimal cutoff value of 62 kPa for elasticity, the diagnostic sensitivity was 88.0% (95%CI: 81.5-92.8%) and specificity was 86.7% (95%CI: 79.5-91.9%), with an accuracy of 89.0%. The area under the ROC curve (AUC) for elasticity alone was 0.95 (95%CI: 0.92-0.98), which improved to 0.97 (95%CI: 0.94-0.99) when combined with strain ratio (P = 0.018). High interobserver agreement was demonstrated (Kappa = 0.84, 95%CI: 0.79-0.88), and Bland-Altman analysis confirmed excellent measurement reliability. CONCLUSION Ultrasound elastography demonstrates high diagnostic accuracy in differentiating between malignant and benign breast microcalcifications, with excellent reproducibility and reliability. The combination of elasticity values and strain ratio provides superior diagnostic performance compared to single parameters alone, suggesting its potential as a valuable tool in clinical practice for the evaluation of breast microcalcifications.
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Affiliation(s)
- Jing Yan
- Department of Ultrasound Medicine, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, 410002, China.
- , No. 61, jiefang West Road, Furong District, Changsha City, Hunan Province, 410002, China.
| | - Sisi Fang
- General emergency department, Hunan Children's Hospital, Changsha, Hunan Province, 410001, China
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Chervenkov L, Georgiev A, Doykov M, Velikova T. Breast cancer imaging-clinical experience with two-dimensional-shear wave elastography: A retrospective study. World J Radiol 2024; 16:528-536. [PMID: 39494133 PMCID: PMC11525830 DOI: 10.4329/wjr.v16.i10.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/29/2024] [Accepted: 09/06/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Breast cancer morbidity has been increasing worldwide, but treatments are improving. The therapeutic response depends on the stage at which the disease is diagnosed. Therefore, early diagnosis has never been more essential for successful treatment and a reduction in mortality rates. Radiology plays a pivotal role in cancer detection, and advances in ultrasound (US) palpation have shown promising results for breast cancer imaging. The addition of two-dimensional-shear wave elastography (2D-SWE) US in the routine breast imaging exam can increase early cancer detection and promote better surveillance. AIM To evaluate the clinical applications of 2D-SWE US in breast cancer detection and its combination with other imaging modalities. METHODS The 200 consecutive female patients aged 50-80 were examined to evaluate palpable breast lesions. All patients underwent mammography, bright mode (B-mode) US, and 2D-SWE followed by US-guided biopsy in two consecutive sessions. RESULTS Combining B-mode and shear wave US imaging with X-ray mammography revealed 100% of the suspicious lesions, resulting in greater sensitivity, specificity, and negative predictive value. The result improves compared to either B-mode or 2D-SWE alone (P = 0.02). CONCLUSION Combining 2D-SWE with conventional US and X-ray techniques improves the chance of early cancer detection. Including 2D-SWE in regular breast imaging routines can reduce the need for biopsies and improve the chance of early cancer detection and survivability with the proper line of therapy.
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Affiliation(s)
- Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Plovdiv 4000, Bulgaria
- Research Complex for Translational Neuroscience, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
| | - Aleksandar Georgiev
- Department of Diagnostic Imaging, Medical University Plovdiv, Plovdiv 4000, Bulgaria
| | - Mladen Doykov
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv 4001, Bulgaria
| | - Tsvetelina Velikova
- Department of Medical Faculty, Sofia University St Kliment Ohridski, Sofia 1407, Bulgaria
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Eremici I, Borlea A, Dumitru C, Stoian D. Factors Associated with False Positive Breast Cancer Results in the Real-Time Sonoelastography Evaluation of Solid Breast Lesions. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1023. [PMID: 39064452 PMCID: PMC11279031 DOI: 10.3390/medicina60071023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/07/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Breast cancer is one of the most widespread cancers among the female population around the world and is curable if diagnosed in an early stage. Consequently, breast cancer screening imaging techniques have greatly evolved and adjusted over the last decades. Alongside mammography, sonoelastography became an important tool for breast cancer detection. However, sonoelastography still has its limitations, namely, there is still a high occurrence of false positive results in the BIRADS 4 category. The aim of our study is to identify potential false positive predictors and to ascertain the factors influencing the quality of strain ultrasound elastography for the evaluation of suspicious solid breast lesions categorized as BIRADS 4B, 4C, and 5. Materials and Methods: We conducted a retrospective study in a single private medical center in Timisoara between January 2017 and January 2022 analyzing 1625 solid breast lesions by the sonoelastography strain using a standardized BIRADS-US lexicon. Results: Our study showed that most sonoelastography factors linked to incorrect and overdiagnosis were due to a nodule dimension (OR = 1.02 per unit increase), posterior acoustic shadowing (OR = 12.26), reactive adenopathy (OR = 6.35), and an increased TES score (TES3 OR = 6.60; TES4 OR = 23.02; TES5 OR = 108.24). Regarding patient characteristics, age (OR = 1.09 per unit increase), BMI, (OR = 1.09 per unit increase), and breastfeeding history (OR = 3.00) were observed to increase the likelihood of false positive results. On the other hand, the nodules less likely to be part of the false positive group exhibited the following characteristics: a regular shape (OR = 0.27), homogenous consistency (OR = 0.42), and avascularity (OR = 0.22). Conclusions: Older age, high BMI, patients with a breastfeeding history, and those who exhibit the following specific nodule characteristics were most often linked to false positive results: large tumors with posterior acoustic shadowing and high elasticity scores, accompanied by reactive adenopathy. On the other hand, homogenous, avascular nodules with regular shapes were less likely to be misdiagnosed.
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Affiliation(s)
- Ivana Eremici
- PhD School, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Andreea Borlea
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Catalin Dumitru
- Obstetrics and Gynecology Department, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dana Stoian
- Department of Internal Medicine II, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Li W, Zheng Y, Liu H, Tai Z, Zhu H, Li Z, Gu Q, Li Y. Multimodal ultrasound imaging for diagnostic differentiation of sclerosing adenosis from invasive ductal carcinoma. Quant Imaging Med Surg 2024; 14:877-887. [PMID: 38223094 PMCID: PMC10784066 DOI: 10.21037/qims-23-524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024]
Abstract
Background Sclerosing adenosis (SA) is a common proliferative benign lesion without atypia in the breast that may mimic invasive ductal carcinoma (IDC) on medical imaging, leading to it often being misdiagnosed and mistreated. Consequently, the purpose of this study was to assess the diagnostic value of multimodal ultrasound imaging in distinguishing SA from IDC. Methods Multimodal ultrasound imaging, including automated breast volume scan (ABVS), elasticity imaging (EI), and color Doppler flow imaging (CDFI), were performed on 120 consecutive patients comprising 122 breast lesions (54 SA, 68 IDC). All lesions were pathologically confirmed. Multimodal ultrasound imaging features were compared between the two groups. Binary logistic regression analysis based on ABVS, EI, and CDFI was conducted to formulate a logistic regression equation for differentiating SA from IDC. The diagnostic performances of ABVS, EI, CDFI, and their combination were compared by the receiver operating characteristic (ROC) curve analysis. Results The sensitivity, specificity, and accuracy of ABVS, EI, CDFI, and their combination in differentiating SA from IDC were, respectively, 75.00%, 72.22%, and 73.77%; 86.76%, 72.22%, and 80.33%; 73.53%, 64.81%, and 69.67%; and 88.24%, 74.07%, and 81.97%. Combining multimodal ultrasound imaging yielded an area under the curve (AUC) of 0.895 (95% confidence interval: 0.827-0.943), which was higher than that of ABVS, EI, and CDFI, with AUC values of 0.736, 0.795, and 0.692, respectively, and the difference was statistically significant (ABVS vs. combined model, P<0.001; CDFI vs. combined model, P<0.001; EI vs. combined model, P<0.001). There was no significant difference in the diagnostic efficacy among the three imaging modalities (ABVS vs. EI, P=0.266; ABVS vs. CDFI, P=0.4671; EI vs. CDFI, P=0.051). Compared with those in IDC, the calcification (16.67% vs. 57.35%; P<0.001) and retraction phenomena in the coronal planes (18.52% vs. 57.35%; P<0.001) were less common in patients with SA, while circumscribed margin (38.89% vs. 5.88%; P<0.001), vascularity grade 0-I (64.81% vs. 26.47%; P<0.001), and elasticity scores 1-3 (72.22% vs. 13.24%; P<0.001) were more frequently found in patients with SA. Patients with SA were significantly younger than were patients with IDC (43±11 vs. 54±11 years; P<0.001), and the lesion size was smaller in patients with SA than in those with IDC (median size 1.0 cm; interquartile range (IQR), 0.9 cm vs. median size 1.3 cm; IQR, 1.3 cm; P<0.001). Conclusions The preliminary results suggested that multimodal ultrasound imaging can improve the diagnostic accuracy of SA and provide additional information for differential diagnosis of SA and IDC.
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Affiliation(s)
- Wen Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Ultrasound, Huadong Sanatorium, Wuxi, China
| | - Yan Zheng
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haizhen Liu
- Department of Ultrasound, Huadong Sanatorium, Wuxi, China
| | - Zhengling Tai
- Department of Ultrasound, Huadong Sanatorium, Wuxi, China
| | - Huihui Zhu
- Department of Ultrasound, Huadong Sanatorium, Wuxi, China
| | - Zhaoxi Li
- Department of Ultrasound, Huadong Sanatorium, Wuxi, China
| | - Qinghua Gu
- Department of Radiology, Suzhou Yongding Hospital, Suzhou, China
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Medical Imaging, Soochow University, Suzhou, China
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Suzhou, China
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Du Y, Yi CB, Du LW, Gong HY, Ling LJ, Ye XH, Zong M, Li CY. Combining primary tumor features derived from conventional and contrast-enhanced ultrasound facilitates the prediction of positive axillary lymph nodes in Breast Imaging Reporting and Data System category 4 malignant breast lesions. Diagn Interv Radiol 2023; 29:469-477. [PMID: 36994900 PMCID: PMC10679605 DOI: 10.4274/dir.2022.22534] [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: 05/23/2021] [Accepted: 07/30/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To determine whether the primary tumor features derived from conventional ultrasound (US) and contrast-enhanced US (CEUS) facilitate the prediction of positive axillary lymph nodes (ALNs) in breast cancer diagnosed as Breast Imaging Reporting and Data System (BI-RADS) category 4. METHODS A total of 240 women with breast cancer who underwent preoperative conventional US, strain elastography, and CEUS between September 2016 and December 2019 were included. The multiple parameters of the primary tumor were obtained, and univariate and multivariate analyses were performed to predict positive ALNs. Then three prediction models (conventional US features, CEUS features, and the combined features) were developed, and the diagnostic performance was evaluated with receiver operating characteristic curves. RESULTS On conventional US, the traits of large size and the non-circumscribed margin of the primary tumor were marked as two independent predictors. On CEUS, the features of vessel perforation or distortion and the enhanced range of the primary tumor were marked as two independent predictors for positive ALNs. Three prediction models were then developed: model A (conventional US features), model B (CEUS features), and model C (model A plus B). Model C yielded the highest area under the curve (AUC) of 0.82 [95% confidence interval (CI), 0.75-0.88] compared with model A (AUC 0.74; 95% CI, 0.68-0.81; P = 0.008) and model B (AUC 0.72; 95% CI, 0.65-0.80; P < 0.001) as per the DeLong test. CONCLUSION CEUS, as a non-invasive examination technique, can be used to predict ALN metastasis. Combining conventional US and CEUS may produce favorable predictive accuracy for positive ALNs in BI-RADS category 4 breast cancer.
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Affiliation(s)
- Yu Du
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chun-Bei Yi
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Wen Du
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Yan Gong
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Jun Ling
- Department of Breast Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin-Hua Ye
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Zong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Cui-Ying Li
- Department of Ultrasound, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Wu LT, Wang JL, Wang YL. Ophthalmic artery changes in type 2 diabetes with and without acute coronary syndrome. J Transl Med 2022; 20:512. [PMCID: PMC9636615 DOI: 10.1186/s12967-022-03712-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Ocular blood flow provides a new perspective for studying the effects of diabetes and ischemic heart disease on systemic blood flow, pathological mechanisms, and prognosis. Previous studies have analyzed the hemodynamic changes of the ophthalmic artery (OA) in patients with diabetes and ischemic heart disease, but the results remain controversial due to limited observation methods. We aimed to explore the morphological and hemodynamic features in the OA in patients with type 2 diabetes (T2D) with and without acute coronary syndrome (ACS).
Methods
In total, 134 participants, including 30 control participants, 34 with ACS only, 34 with T2D only, and 36 with both ACS and T2D, undergoing computed tomography angiography were enrolled. Three-dimensional OA models were reconstructed, and morphological parameters of the OA were measured. In addition, numerical simulations using computational fluid dynamics were used to acquire hemodynamic parameters of the OA.
Results
In this study, 134 OA models were reconstructed. Morphological measurements revealed a smaller initial OA diameter in the T2D group than in the other two ACS groups. A hemodynamic simulation showed a significantly lower OA blood velocity in patients with ACS and T2D than that in controls (P < 0.001). The mass flow ratios in all disease groups were lower than those in the control group (P < 0.001, P = 0.020, and P < 0.001, respectively). The ACS and T2D groups had higher OA pressure levels than those of the control group (P = 0.013). The OA blood velocity and mass flow ratio were correlated with several clinical parameters.
Conclusions
This study revealed morphological and hemodynamic differences in the OA between patients with T2D with and without ACS. Furthermore, the hemodynamic characteristics of the OA correlated with clinical prognostic biomarkers, suggesting the potential predictive ability of the OA.
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Xu M, Li F, Yu S, Zeng S, Weng G, Teng P, Yang H, Li X, Liu G. Value of Histogram of Gray-Scale Ultrasound Image in Differential Diagnosis of Small Triple Negative Breast Invasive Ductal Carcinoma and Fibroadenoma. Cancer Manag Res 2022; 14:1515-1524. [PMID: 35478712 PMCID: PMC9038159 DOI: 10.2147/cmar.s359986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the value of gray-scale ultrasound (US) image histogram in the differential diagnosis between small (≤2.00 cm), oval, or round triple negative breast invasive ductal carcinoma (TN-IDC) and fibroadenoma (FA). Methods Fifty-five cases of triple negative breast invasive ductal carcinoma (TN-IDC group) and 57 cases of breast fibroadenoma (FA group) confirmed by pathology in Hubei cancer hospital from September 2017 to September 2021 were analyzed retrospectively. The gray-scale US images were analyzed by histogram analysis method, from which some parameters (including mean, variance, skewness, kurtosis and 1st, 10th, 50th, 90th and 99th percentile) can be obtained. Intraclass correlation coefficient (ICC) was used to evaluate the inter observer reliability of histogram parameters. Histogram parameters between the TN-IDC and FA groups were compared using independent Student’s t-test or Mann-Whitney U-test, respectively. In addition, the receiver operating characteristic (ROC) curve analysis was used for the significant parameters to calculate the differential diagnosis efficiency. Results All the histogram parameters showed excellent inter-reader consistency, with the ICC values ranged from 0.883 to 0.999. The mean value, 1st, 10th, 50th, 90th and 99th percentiles of TN-IDC group were significantly lower than those of FA group (P < 0.05). The area under ROC curve (AUC) values of mean and n percentiles were from 0.807 to 0.848. However, there were no significant differences in variance, skewness and kurtosis between the two groups (P > 0.05). Conclusion Histogram analysis of gray-scale US images can well distinguish small, oval, or round TN-IDC from FA.
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Affiliation(s)
- Maolin Xu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Fang Li
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Shaonan Yu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Shue Zeng
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Gaolong Weng
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Peihong Teng
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Huimin Yang
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
| | - Xuefeng Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
- Correspondence: Xuefeng Li, Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Xiantai Street, Changchun, 130033, People’s Republic of China, Email
| | - Guifeng Liu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, People’s Republic of China
- Guifeng Liu, Department of Radiology, China-Japan Union Hospital of Jilin University, Xiantai Street, Changchun, 130033, People’s Republic of China, Email
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