title: Ultrasound elastography as an adjuvant to conventional ultrasound in the preoperative assessment of axillary lymph nodes in suspected breast cancer: a pilot study.
abstract: OBJECTIVE
  To compare the performance of ultrasound elastography with conventional ultrasound in the assessment of axillary lymph nodes in suspected breast cancer and whether ultrasound elastography as an adjunct to conventional ultrasound can increase the sensitivity of conventional ultrasound used alone.
  
  
  METHODS
  Fifty symptomatic women with a sonographic suspicion for breast cancer underwent ultrasound elastography of the ipsilateral axilla concurrent with conventional ultrasound being performed as part of triple assessment. Elastograms were visually scored, strain measurements calculated and node area and perimeter measurements taken. Theoretical biopsy cut points were selected. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated and receiver operating characteristic (ROC) analysis was performed and compared for elastograms and conventional ultrasound images with surgical histology as the reference standard.
  
  
  RESULTS
  The mean age of the women was 57 years. Twenty-nine out of 50 of the nodes were histologically negative on surgical histology and 21 were positive. The sensitivity, specificity, PPV, and NPV for conventional ultrasound were 76, 78, 70, and 81%, respectively; 90, 86, 83, and 93%, respectively, for visual ultrasound elastography; and for strain scoring, 100, 48, 58 and 100%, respectively. There was no significant difference between any of the node measurements
  
  
  CONCLUSIONS
  Initial experience with ultrasound elastography of axillary lymph nodes, showed that it is more sensitive than conventional ultrasound in detecting abnormal nodes in the axilla in cases of suspected breast cancer. The specificity remained acceptable and ultrasound elastography used as an adjunct to conventional ultrasound has the potential to improve the performance of conventional ultrasound alone.
authors.affiliation: Department of Radiology, Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. kathryn.taylor@addenbrookes.nhs.uk
authors.forename: K
authors.initials: K
authors.lastname: Taylor
authors.forename: S
authors.initials: S
authors.lastname: O'Keeffe
authors.forename: P D
authors.initials: PD
authors.lastname: Britton
authors.forename: M G
authors.initials: MG
authors.lastname: Wallis
authors.forename: G M
authors.initials: GM
authors.lastname: Treece
authors.forename: J
authors.initials: J
authors.lastname: Housden
authors.forename: D
authors.initials: D
authors.lastname: Parashar
authors.forename: S
authors.initials: S
authors.lastname: Bond
authors.forename: R
authors.initials: R
authors.lastname: Sinnatamby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary