title: Assessment of breast cancer tumour size using six different methods.
abstract: OBJECTIVE
  Tumour size estimates using mammography (MG), conventional ultrasound (US), compound imaging (CI) and real-time elastography (RTE) were compared with histopathological specimen sizes.
  
  
  METHODS
  The largest diameters of 97 malignant breast lesions were measured. Two US and CI measurements were made: US1/CI1 (hypoechoic nucleus only) and US2/CI2 (hypoechoic nucleus plus hyperechoic halo). Measurements were compared with histopathological tumour sizes using linear regression and Bland-Altman plots.
  
  
  RESULTS
  Size prediction was best with ultrasound (US/CI/RTE: R (2) 0.31-0.36); mammography was poorer (R(2) = 0.19). The most accurate method was US2, while US1 and CI1 were poorest. Bland-Altman plots showed better size estimation with US2, CI2 and RTE, with low variation, while mammography showed greatest variability. Smaller tumours were better assessed than larger ones. CI2 and US2 performed best for ductal tumours and RTE for lobular cancers. Tumour size prediction accuracy did not correlate significantly with breast density, but on MG tumours were more difficult to detect in high-density tissue.
  
  
  CONCLUSIONS
  The size of ductal tumours is best predicted with US2 and CI2, while for lobular cancers RTE is best. Hyperechoic tumour surroundings should be included in US and CI measurements and RTE used as an additional technique in the clinical staging process.
authors.affiliation: Institute of Diagnostic Radiology, Erlangen University Hospital, Erlangen, Germany. martina.meier-meitinger@uk-erlangen.de
authors.forename: Martina
authors.initials: M
authors.lastname: Meier-Meitinger
authors.forename: Lothar
authors.initials: L
authors.lastname: Häberle
authors.forename: Peter A
authors.initials: PA
authors.lastname: Fasching
authors.forename: Mayada R
authors.initials: MR
authors.lastname: Bani
authors.forename: Katharina
authors.initials: K
authors.lastname: Heusinger
authors.forename: David
authors.initials: D
authors.lastname: Wachter
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schulz-Wendtland
authors.forename: Boris
authors.initials: B
authors.lastname: Adamietz
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000175:diagnosis*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D016247:Information Storage and Retrieval / Q000379:methods*; D008327:Mammography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity