title: A pilot study to evaluate assisted freehand ultrasound elasticity imaging in the sizing of early breast cancer: a comparison of B-mode and AFUSON elasticity ultrasound with histopathology measurements.
abstract: OBJECTIVE
  This pilot study investigates the role of assisted-freehand ultrasound (AFUSON) elasticity imaging of the breast in assessing the contour, size and area of 23 early breast cancers by making comparison of AFUSON with the equivalent B-mode ultrasound images and gold standard histopathology slides.
  
  
  METHODS
  The B-mode, AFUSON and digitised histopathology slides of three early breast cancers were compared for contour, size and area with histopathology scans. AFUSON features that corresponded to areas of known malignant change on the histopathology slides were regarded as diagnostic. These diagnostic criteria were then applied to the B-mode and AFUSON elasticity images of all 23 breast cancers in the pilot study without having the availability of the histopathology scans for reference. Corresponding diameters were measured and the results were compared with the equivalent measurements on the scans of the histology slides. The results were tabulated in histogram form. Diagnostic confidence levels were evaluated.
  
  
  RESULTS
  Size dimension accuracy increased from 66% using B-mode alone to 82% using combined B-mode and AFUSON elasticity images. Tumour area accuracy was also increased. A small number of cases had a striking visual similarity of shape on AFUSON elasticity scans and histopathology slides.
  
  
  CONCLUSIONS
  In spite of the shortfalls in this study, AFUSON elasticity imaging was capable of acquiring some high-quality images that showed strong correlation between AFUSON elasticity and scans of histology slides. Further studies will be carried out to refine the technique and determine if it has a role in the diagnosis and management of breast cancer.
authors.affiliation: Oxford Breast Imaging Centre, Oxford Radcliffe Hospitals NHS Trust, Oxford UK. ruth.english@orh.nhs.uk
authors.forename: R E
authors.initials: RE
authors.lastname: English
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: A J C
authors.initials: AJ
authors.lastname: Parker
authors.forename: D
authors.initials: D
authors.lastname: Roskell
authors.forename: R F
authors.initials: RF
authors.lastname: Adams
authors.forename: V
authors.initials: V
authors.lastname: Parulekar
authors.forename: J
authors.initials: J
authors.lastname: Baldwin
authors.forename: Y
authors.initials: Y
authors.lastname: Chi
authors.forename: J A
authors.initials: JA
authors.lastname: Noble
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology; D018275:Carcinoma, Lobular / Q000473:pathology; D055088:Early Detection of Cancer; D054459:Elasticity Imaging Techniques / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000295:instrumentation* / Q000379:methods