title: A role for elastography in the diagnosis of breast lesions by measuring the maximum fat lesion ratio (max-FLR) by tissue Doppler imaging.
abstract: BACKGROUND
  The role of elastography for breast tumors is still ambiguous. The purpose of this study was to inquire how effectively elastography can be used in the diagnosis of breast tumors.
  
  
  METHODS
  The fat lesion ratio (FLR) of 244 lesions (99 malignant and 145 benign lesions) was calculated using tissue Doppler imaging with elastography. The pathological confirmations were performed by core needle or excisional biopsy. Conventional ultrasonography (US) findings were classified according to the Breast Imaging Reporting and Data System. We tried to set the region of interest (ROI) at the hardest area of the target and measured the maximum FLR (max-FLR) of the target with elastography, whereas the control ROI was placed in the subcutaneous adipose tissue. The diagnostic potential of the max-FLR combined with the US category was evaluated.
  
  
  RESULTS
  The mean max-FLR of malignant lesions was significantly greater than that of benign lesions, at 11.0 and 4.4, respectively (p < 0.01). The max-FLR showed a wide overlap range between benign and malignant lesions, but there were no malignant lesions showing a less than 2.0 max-FLR. Ninety-six percent of the lesions interpreted as category 3 were benign, and the negative predictive value measuring the max-FLR was kept at 98% as long as the max-FLR was less than 4.0. Measuring the max-FLR may reduce unnecessary biopsies by 57.5% in the category 3 group.
  
  
  CONCLUSIONS
  Combining conventional US categories and measuring max-FLR with elastography may be helpful in reducing the number of unnecessary biopsies in category 3 lesions.
authors.affiliation: Department of Breast Surgical Oncology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka, 534-0021, Japan. bfaqt406@cwo.zaq.ne.jp
authors.forename: Katsumi
authors.initials: K
authors.lastname: Ikeda
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Ogawa
authors.forename: Mamiko
authors.initials: M
authors.lastname: Takii
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugano
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ikeya
authors.forename: Shinya
authors.initials: S
authors.lastname: Tokunaga
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nishiguchi
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Ikehara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000379:methods