title: Real-time elastography--an advanced method of ultrasound: First results in 108 patients with breast lesions.
abstract: OBJECTIVE
  To evaluate whether real-time elastography, a new, non-invasive method for the diagnosis of breast cancer, improves the differentiation and characterization of benign and malignant breast lesions.
  
  
  METHODS
  Real-time elastography was carried out in 108 potential breast tumor patients with cytologically or histologically confirmed focal breast lesions (59 benign, 49 malignant; median age, 53.9 years; range, 16-84 years). Tumor and healthy tissue were differentiated by measurement of elasticity based on the correlation between tissue properties and elasticity modulus. Evaluation was performed using the three-dimensional (3D) finite element method, in which the information is color-coded and superimposed on the B-mode ultrasound image. A second observer evaluated the elastography images, in order to improve the objectivity of the method. The results of B-mode scan and elastography were compared with those of histology and previous sonographic findings. Sensitivities and specificities were calculated, taking histology as the gold standard.
  
  
  RESULTS
  B-mode ultrasound had a sensitivity of 91.8% and a specificity of 78%, compared with sensitivities of 77.6% and 79.6% and specificities of 91.5% and 84.7%, respectively, for the two observers evaluating elastography. Agreement between B-mode ultrasound and elastography was good, yielding a weighted kappa of 0.67.
  
  
  CONCLUSIONS
  Our initial clinical results suggest that real-time elastography improves the specificity of breast lesion diagnosis and is a promising new approach for the diagnosis of breast cancer. Elastography provides additional information for differentiating malignant BI-RADS (breast imaging reporting and data system) category IV lesions.
authors.affiliation: Department of Obstetrics and Gynecology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany. anke.thomas@charite.de
authors.forename: A
authors.initials: A
authors.lastname: Thomas
authors.forename: T
authors.initials: T
authors.lastname: Fischer
authors.forename: H
authors.initials: H
authors.lastname: Frey
authors.forename: R
authors.initials: R
authors.lastname: Ohlinger
authors.forename: S
authors.initials: S
authors.lastname: Grunwald
authors.forename: J-U
authors.initials: JU
authors.lastname: Blohmer
authors.forename: K-J
authors.initials: KJ
authors.lastname: Winzer
authors.forename: S
authors.initials: S
authors.lastname: Weber
authors.forename: G
authors.initials: G
authors.lastname: Kristiansen
authors.forename: B
authors.initials: B
authors.lastname: Ebert
authors.forename: S
authors.initials: S
authors.lastname: Kümmel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D004548:Elasticity; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014463:Ultrasonography