title: Differentiating benign from malignant solid breast masses with US strain imaging.
abstract: OBJECTIVE
  To prospectively evaluate the sensitivity and specificity of ultrasonographic (US) strain imaging for distinguishing between benign and malignant solid breast masses, with biopsy results as the reference standard.
  
  
  METHODS
  The study was institutional review board approved and HIPAA compliant. Informed consent was obtained from all participating patients. US strain imaging of 403 breast masses was performed. The 50 malignant and 48 benign lesions (in patients aged 19-83 years; mean age, 49 years +/- 17 [standard deviation]) with the highest quality were selected for the reader study. Three observers blinded to the pathologic outcomes first described the B-mode image findings by using US Breast Imaging Reporting and Data System descriptors and derived a probability of malignancy. They then updated the probability by assessing strain images. Receiver operating characteristic (ROC) curves were constructed by using these probabilities. Areas under the ROC curve, sensitivities, and specificities were calculated and compared. Interobserver variability and the correlation between automated and subjective image quality assessment were analyzed.
  
  
  RESULTS
  The average area under the ROC curve for all three readers after US strain imaging (0.903) was greater than that after B-mode US alone (0.876, P = .014). With use of a 2% probability of malignancy threshold, strain imaging-as compared with B-mode US alone-had improved average specificity (0.257 vs 0.132, P < .001) and high sensitivity (0.993 vs 0.987, P > .99). Significant interobserver variability was observed (P < .001). The ability to assess strain image quality appeared to correlate with the highest observer performance.
  
  
  CONCLUSIONS
  US strain imaging can facilitate improved classification of benign and malignant breast masses. However, interobserver variability and image quality influence observer performance.
authors.affiliation: Department of Radiology, University of Wisconsin Medical School, E3/311 Clinical Science Center, Madison, WI 53792-3252, USA. eburnside@uwhealth.org
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Burnside
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Hall
authors.forename: Amy M
authors.initials: AM
authors.lastname: Sommer
authors.forename: Gina K
authors.initials: GK
authors.lastname: Hesley
authors.forename: Gale A
authors.initials: GA
authors.lastname: Sisney
authors.forename: William E
authors.initials: WE
authors.lastname: Svensson
authors.forename: Jason P
authors.initials: JP
authors.lastname: Fine
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Jiang
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Hangiandreou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D016247:Information Storage and Retrieval / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*