Elastography Useful as Adjunct to Breast US


Major Finding: Elastography correctly identified 98% of lesions shown on biopsy to be malignant, and 78% of lesions shown on biopsy to be benign.

Data Source: A study of 193 women.

Disclosures: Dr. Destounis disclosed being a consultant for Carestream Health Inc., an advisory board member for Siemens AG, and an investigator for Siemens, Fujifilm Holdings Corp., Hologic Inc., and U-Systems Inc.

CHICAGO — The use of elastography, or the ability to measure the stiffness of lesions during ultrasound, may help distinguish benign from malignant breast lesions, suggest results of a study of 193 women.

Elastography correctly identified 98% of lesions that were shown on biopsy to be malignant. With biopsied benign lesions, elastography properly identified 78% of the lesions, Dr. Stamatia V. Destounis, a diagnostic radiologist at a breast-imaging and diagnosis center in Rochester, N.Y., reported in a poster at the annual meeting of the Radiological Society of North America.

“The addition of elastography could potentially help decrease the need to perform a biopsy, or could reduce the need for additional imaging of benign lesions, thus reducing the associated patient anxiety,” she told reporters, noting that as many as 20% of young women have breast fibroadenomas.

Elastography software has been available for some time, but is having a resurgence in recent years, particularly in thyroid, prostate, and breast applications as the technology advances and the software is included on new imaging units. The technology can also be applied to a standard unit without an additional upgrade, with the images read side by side, she said at a press briefing.

Overall, elasticity imaging increases the specificity of ultrasound by measuring the compressibility and mechanical properties of a lesion. Tumors are typically stiffer than surrounding tissue, whereas cysts demonstrate a “bull's eye” appearance on elastography, Dr. Destounis said. Cancerous lesions also tend to be larger than benign findings on elastography.

The study was conducted in 2007-2009 and included 193 patients (average age, 54 years) who underwent elastography at the time of standard breast ultrasound utilizing a Siemens Sonoline Antares or Siemens S2000 ultrasound unit.

A total of 58 lesions did not undergo biopsy and were predetermined to be benign. Biopsies were performed in 140 lesions, of which 59 were cancers, 69 were benign, 1 was an atypical papillary neoplasm, and 11 were cyst aspirations in which fluid was drained and the abnormality resolved. Of the 140 biopsies, the elastogram image correlated with the standard B-mode ultrasound image in 58 of the 59 cancers (98%), said Dr. Destounis, also of the department of imaging sciences at the University of Rochester.

Of the 69 benign findings observed, the elastogram and B-mode ultrasound images correlated in 54 (78%) of cases. Four did not correlate and measured larger on elastography, and 11 cases were unclear, she said.

Although the data are early, elastography is a promising adjunct imaging tool, Dr. Destounis said.

“Women are becoming more and more concerned about unnecessary procedures and unnecessary needle biopsies and the anxiety that creates,” she said. “I think this may be an additional tool, specifically for some of the benign findings like the fibroadenomas in young women or some of the cystic structures that you can really identify with elastography. You have to use your clinical judgment. I'm not using elastography in a vacuum. I'm using it in correlation with everything else.”

For some women, the information gained through elastography will be enough to defer a biopsy, but others will not be comfortable until a biopsy has been performed, she said.

Although the data are early, elastography is a promising adjunct imaging tool.


This ultrasound (left) shows a solid mass. When elasticity software is applied, the mass is noticeably larger (right). Biopsy proved this to be invasive cancer.

The nodule on ultrasound (left) appears consistent with a known fibroadenoma. Elasticity imaging (right) shows the fibroadenoma as markedly smaller.

Source Images courtesy Radiological Society of North America

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