title: Clinical value of relative quantification ultrasound elastography in characterizing breast tumors.
abstract: OBJECTIVE
  To evaluate ultrasound elastography (USE) using strain ratio (SR), a relative quantification approach for breast lesions characterization.
  
  
  METHODS
  One hundred forty-seven consecutive patients with a total of 156 breast lesions underwent USE. Technical accuracy was assessed automatically. For SR evaluation a rounded ROI was depicted inside fat (F), glandular tissue (G) and inside the lesion (L), preferably at the same depth. R1, mean value of the G and F ratio, stands for in background tissue composition elasticity. R2; mean value of L/F stands for in lesion elasticity, both evaluated in arbitrary unit (au). Two-years follow-up and pathology results were standard of reference. Mann-Whitney test, ROC analysis and Chi-square with Yates correction were used.
  
  
  RESULTS
  With the exception of 27 cysts, 17 malignant and 112 benign lesions were found. R1 values were 1.6±0.7au and 1.2±0.9au (p=0.015 NS); R2 values were 6.1±2.5au and 1.9±1.3au (p<0.001) for malignant and benign lesions, respectively. A threshold of 3.3au showed a sensitivity and specificity of 88% and 87%, respectively with an AUC of 93%. Fifteen false positive and two false negative were detected.
  
  
  CONCLUSIONS
  Relative quantification of ultrasound elastography allows to find high levels of diagnostic accuracy in characterizing breast tumors above all in downgrading BI-RADS 3 and 4 lesions.
authors.affiliation: Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Policlinico Universitario 'Santa Maria alle Scotte', Viale Bracci 16, 53100 Siena, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fausto
authors.affiliation: Department of Radiology, Nuclear Medicine, Medical Physics, Head Service of Nuclear Medicine, PET/CT Centre, 'Santa Maria della Misericordia Hospital', Via Tre Martiri 8, 45100 Rovigo, Italy. Electronic address: domenico.rubello@libero.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.affiliation: Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Strada delle Scotte 2, 53100 Siena, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Carboni
authors.affiliation: Department of Radiology, Nuclear Medicine, Medical Physics, Head Service of Nuclear Medicine, PET/CT Centre, 'Santa Maria della Misericordia Hospital', Via Tre Martiri 8, 45100 Rovigo, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Mastellari
authors.affiliation: Department of Radiology, Nuclear Medicine, Medical Physics, Head Service of Nuclear Medicine, PET/CT Centre, 'Santa Maria della Misericordia Hospital', Via Tre Martiri 8, 45100 Rovigo, Italy.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Chondrogiannis
authors.affiliation: Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Policlinico Universitario 'Santa Maria alle Scotte', Viale Bracci 16, 53100 Siena, Italy; Department of Radiology, Nuclear Medicine, Medical Physics, Head Service of Nuclear Medicine, PET/CT Centre, 'Santa Maria della Misericordia Hospital', Via Tre Martiri 8, 45100 Rovigo, Italy; Department of Medical, Surgical and Neuro Sciences, Diagnostic Imaging, University of Siena, Strada delle Scotte 2, 53100 Siena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Volterrani
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: Breast neoplasm; Elastography; Strain ratio; Tissue characterization; Ultrasound