Diagnostic potential of strain ratio measurement and a 5 point scoring method for detection of breast cancer: Chinese experience.
OBJECTIVE
To evaluate the differential diagnostic potential of lesion stiffness assessed by the sonoelastographic strain index ratio (SR) and elastographic color scoring system (UE) for breast lesions.


METHODS
Three hundred and forty two breast masses (158 benign and 184 malignant) from 325 consecutive patients (mean age 44.2 years; range 16-81)who had been scheduled for a sonographically guided core biopsy were examined with grey scale sonography,doppler sonography and sonoelastography. Each lesion was classified with ACR's BI-RADS assessment category (2, 3 and 4A=Benign and; 4B, 4C, 5=Malignant) and the 5-point scoring system proposed by Itoh et al, with scoring 1-3=benign and 4-5=malignant. Strain and area ratios of each lesion were calculated within the same machine. Histological diagnosis was used as the reference standard. The area under the curve (AUC) and cut-off point were obtained by receiver operating curve and the cross table Fischer Test was carried out for assessing diagnostic value. Sensitivity, specificity, PPV, NPV, accuracy and false-discovery rates were compared.


RESULTS
The mean strain ratios for benign and malignant lesions were 1.87 and 7.9 respectively. (P<0.0001). When a cutoff point of 3.54 was used, SR had a sensitivity of 94.6%, a specificity 94.3%, a PPV of 95.1%, an NPV of 93.7% and an accuracy of 94.4%. The AUC values were 0.90 for the 5 point scoring system (UE) and 0.96 for the strain index ratio. The overall diagnostic performance was SR method was better (P<0.05).


CONCLUSIONS
Strain ratio measurement could be another effective predictor in elastography imaging besides 5 the point scoring system for differential diagnosis of breast lesions.
Department of Sonography, Clinical Medicine, West China Hospital of Sichuan University , Chengdu, China.
Shyam Sundar
SS
Parajuly
Peng Yu
PY
Lan
Ma Bu
MB
Yun
Yang Zhi
YZ
Gang
Zhuang
Z
Hua
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000473:pathology; D002681:China; D003116:Color; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D005189:False Positive Reactions; D005260:Female; D018226:Fibroadenoma / Q000000981:diagnostic imaging* / Q000473:pathology; D005348:Fibrocystic Breast Disease / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007089:Image Enhancement; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D018608:Ultrasonography, Doppler; D055815:Young Adult