title: Combined use of the automated breast volume scanner and the US elastography for the differentiation of benign from malignant lesions of the breast.
abstract: BACKGROUND
  Automated breast volume scanner (ABVS) and US elastography (UE) have been useful for the differentiation of benign and malignant lesions. However, combining these two methods applied in diagnosis of breast lesions has not yet been reported. The aim of this study is to analyze the inter-examiner reliability of ABVS and UE, and compare diagnostic performance among ABVS, UE, and the combination of these two methods.
  
  
  METHODS
  Forty-one patients (forty-six lesions) underwent both ABVS and UE examinations. ABVS images were acquired by medial and lateral scans for each breast and classified a BI-RADS category based on the distribution, size, shape, echogenicity and microcalcification of the lesions. UE images were assigned an elasticity score according to the distribution of strain induced by light compression. Kappa statistics was used to examine the reproducibility between examiners with ABVS and UE, and the concordance between pathology and ABVS, UE, and the combination of these two methods. χ2 test was used to compare diagnostic performance among these three methods.Two examiners blinded to the patients' history evaluated the results of breast imaging independently.
  
  
  RESULTS
  Inter-examiner reliability with ABVS (κ = 0.62, 95% confidence interval (CI): 0.44-0.80) and UE (κ = 0.65, 95% CI: 0.48-0.82) was substantial. With respect to the pathology results, the inter-rater coefficient of concordance was κ = 0.81 (95% CI: 0.64-0.98) for ABVS, κ = 0.77 (95% CI: 0.58-0.96) for UE, and κ = 0.90 (95% CI: 0.77-1.00) for combination of ABVS and UE. Examiner variability was reduced from UE to ABVS, and to the combination of ABVS with UE.The diagnostic accuracy, sensitivity, and specificity for the combination of ABVS and UE were 95.7% (95%CI: 84.0-99.2), 100% (95% CI: 85.9-100), and 87.5% (95% CI: 60.4-97.8), respectively. When comparing, the diagnostic performance of ABVS combined with UE was better than, or at least equal to, that of ABVS (accuracy 91.3% (95% CI: 78.3-97.2), sensitivity 100% (95% CI: 85.0-1.00), specificity 77.8% (95% CI: 51.9-92.6)) or UE (accuracy 89.1% (95% CI: 75.6-95.9), sensitivity 96.4% (95% CI: 79.8-99.8), specificity 77.8% (95% CI: 51.9-92.6)) alone, though the improvement was no statistically significance.
  
  
  CONCLUSIONS
  Both ABVS and UE demonstrated substantial inter-examiner reliability. With high diagnostic performance for differentiation of benign and malignant lesions in the breast, the combination of ABVS and UE are useful to improve the diagnostic accuracy and specificity.
authors.forename: Chaoli
authors.initials: C
authors.lastname: Xu
authors.forename: Shuping
authors.initials: S
authors.lastname: Wei
authors.forename: Yingdong
authors.initials: Y
authors.lastname: Xie
authors.forename: Xiaoxiang
authors.initials: X
authors.lastname: Guan
authors.forename: Ninghua
authors.initials: N
authors.lastname: Fu
authors.forename: Pengfei
authors.initials: P
authors.lastname: Huang
authors.affiliation: Department of Ultrasound Diagnostics, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, Jiangsu 210002, China. yb12yx@hotmail.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D009929:Organ Size; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary; D055815:Young Adult