title: Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography.
abstract: OBJECTIVE
  Initial data suggest that elastography can improve the specificity of ultrasound in differentiating benign and malignant breast lesions. The aim of this study was to compare elastography and B-mode ultrasound to determine whether the calculation of strain ratios (SRs) can further improve the differentiation of focal breast lesions.
  
  
  METHODS
  A total of 227 women with histologically proven focal breast lesions (113 benign, 114 malignant) were included at two German breast centers. The women underwent a standardized ultrasound procedure using a high-end ultrasound system with a 9-MHz broadband linear transducer. B-mode scans and sonoelastograms were analyzed by two experienced readers using the Breast Imaging Reporting and Data System criteria. SRs were calculated from a tumor-adjusted region of interest (mean color pixel density) and a comparable region of interest placed in the lateral fatty tissue. Sensitivity, specificity, and cutoff values were calculated for SRs (receiver-operating characteristic analysis).
  
  
  RESULTS
  The women had a mean age of 54 years (range, 19-87 years). The mean lesion diameter was 1.6 +/- 0.9 cm. Sensitivity and specificity were 96% and 56% for B-mode scanning, 81% and 89% for elastography, and 90% and 89% for SRs. An SR cutoff value of 2.45 (area under the curve, 0.949) allowed significant differentiation (P < .001) of malignant (mean, 5.1 +/- 4.2) and benign (mean, 1.6 +/- 1.0) lesions. The quantitative method of SR calculation was superior to subjective interpretation of sonoelastograms and B-mode scans, with a positive predictive value of 89% compared to 68% and 84% for the other two methods.
  
  
  CONCLUSIONS
  Calculation of SRs contributes to the standardization of sonoelastography with high sensitivity and allows significant differentiation of benign and malignant breast lesions with higher specificity compared to B-mode ultrasound but not elastography.
authors.affiliation: Department of Obstetrics and Gynecology, Charité-Universitätsmedizin Berlin, Berlin, Germany. anke.thomas@charite.de
authors.forename: Anke
authors.initials: A
authors.lastname: Thomas
authors.forename: Friedrich
authors.initials: F
authors.lastname: Degenhardt
authors.forename: André
authors.initials: A
authors.lastname: Farrokh
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wojcinski
authors.forename: Torsten
authors.initials: T
authors.lastname: Slowinski
authors.forename: Thomas
authors.initials: T
authors.lastname: Fischer
mesh_terms: D000328:Adult; D000368:Aged; D016880:Anisotropy; D001943:Breast Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003937:Diagnosis, Differential; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult