title: Ultrasonic elastography in breast cancer diagnosis: strain ratio vs 5-point scale.
abstract: OBJECTIVE
  The aim of this study was to develop a more reliable ultrasonic elastographic diagnostic method than a five-point scoring system by analyzing the difference in stiffness between benign and malignant breast lesions.
  
  
  METHODS
  From January 2008 to April 2009, 559 solid lesions (415 benign, 144 malignant) in 437 consecutive patients (age range, 12-77 years) were examined using ultrasound elastography (UE). Final diagnosis was made on the basis of histopathologic findings. The strain ratios of the lesions were calculated. The area under the curve and cutoff point, both of which were obtained using receiver-operating characteristic curve analysis, were used to assess diagnostic performance. Diagnostic performance was further compared to that generated using a five-point scoring system with the z test. The sensitivity, specificity, and accuracy of these two evaluation systems were compared using McNemar's test.
  
  
  RESULTS
  The strain ratios of benign lesions (mean, 1.83 ± 1.22) and malignant lesions (mean, 8.38 ± 7.65) were significantly different (P < .00001). When a cutoff point of 3.05 was introduced, UE had 92.4% sensitivity, 91.1% specificity, and 91.4% accuracy. The area under the curve for strain ratio-based elastographic analysis was 0.944, and the area under the curve for the five-point scoring system was 0.885. The diagnostic performance of strain ratio-based elastographic analysis was better than that of the five-point scoring system with UE (P < .05).
  
  
  CONCLUSIONS
  Strain ratio-based elastographic analysis can provide a new, more reliable diagnostic tool in comparison to a five-point scoring system for UE.
authors.affiliation: Department of Ultrasound, Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510120, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhi
authors.forename: Xiao-Yun
authors.initials: XY
authors.lastname: Xiao
authors.forename: Hai-Yun
authors.initials: HY
authors.lastname: Yang
authors.forename: Bing
authors.initials: B
authors.lastname: Ou
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Wen
authors.forename: Bao-Ming
authors.initials: BM
authors.lastname: Luo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002648:Child; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult