title: Ultrasonic Elastography Research Based on a Multicenter Study: Adding Strain Ratio after 5-Point Scoring Evaluation or Not.
abstract: BACKGROUND
  This study aimed to confirm whether strain ratio should be added after evaluation of lesions with 5-point elasticity scoring for differentiating benign and malignant breast lesions on ultrasonographic elastography(UE).
  
  
  METHODS
  From June 2010 to March 2012, 1080 consecutive female patients with breast lesions were recruited into a multicenter retrospective study, which involved 8 centers across China. Each institutional ethic review board approved the study, and all the patients gave written informed consent. All the patients underwent the UE procedure and the strain ratios were calculated and the final diagnosis was made by histological findings. The sensitivity, specificity, accuracy, PPV and NPV were calculated for each of the two evaluation systems and the areas under the ROC curve were compared.
  
  
  RESULTS
  The strain ratios of benign lesions (mean, 2.6±2.0) and malignant lesions (mean,7.9±5.8) were significantly different (p <0.01). When the cutoff point was 3.01, strain ratio method had 79.8% sensitivity, 82.8% specificity, and 81.3% accuracy, while the 5-point scoring method had 93.1% sensitivity, 73.0% specificity, and 76.8% accuracy. The areas under the ROC curve with the strain ratio method and 5-point scoring method were 0.863 and 0.865, respectively(p>0.05). The strain ratio method shows better a diagnosis performance of the lesions with elasticity score 3 and 4.
  
  
  CONCLUSIONS
  Although the two UE methods have similar diagnostic performance, separate calculation of the strain ratios seems compulsory, especially for the large solid breast lesions and the lesions with elasticity score 3 and 4.
authors: Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
authors: Wen-Jie
authors: WJ
authors: Mu
authors: Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
authors: Wen-Jing
authors: WJ
authors: Zhong
authors: Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
authors: Ji-Yi
authors: JY
authors: Yao
authors: Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
authors: Lu-Jing
authors: LJ
authors: Li
authors: Department of Diagnostic Ultrasound and The National Key Discipline of Medical Imaging and Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
authors: Yu-Lan
authors: YL
authors: Peng
authors: Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, Zhejiang Province, China.
authors: Yi
authors: Y
authors: Wang
authors: Department of Ultrasound, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang Province, China.
authors: Li-Sha
authors: LS
authors: Liu
authors: Department of Ultrasound, Xiangya Hospital, Central-South University, Changsha, Hunan Province, China.
authors: Ying
authors: Y
authors: Xiao
authors: Department of Ultrasound, ShengJing hospital of China Medical University, Shenyang, Liaoning Province, China.
authors: Shou-Jun
authors: SJ
authors: Liu
authors: Department of Ultrasound, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
authors: Chang-Jun
authors: CJ
authors: Wu
authors: Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Hebei Province, China.
authors: Yu-Xin
authors: YX
authors: Jiang
authors: Department of Diagnostic Ultrasound and The National Key Discipline of Medical Imaging and Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
authors: Shyam Sundar
authors: SS
authors: Parajuly
authors: Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, Zhejiang Province, China.
authors: Ping
authors: P
authors: Xu
authors: Department of Ultrasound, Tumor Hospital Affiliated to Xinjiang Medical University, Urumqi, Xinjiang Province, China.
authors: Yi
authors: Y
authors: Hao
authors: Department of Ultrasound, ShengJing hospital of China Medical University, Shenyang, Liaoning Province, China.
authors: Jing
authors: J
authors: Li
authors: Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
authors: Bao-Ming
authors: BM
authors: Luo
authors: Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
authors: Hui
authors: H
authors: Zhi
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis* / Q000473:pathology; D004548:Elasticity; D054459:Elasticity Imaging Techniques / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000473:pathology; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D016217:Ultrasonography, Mammary / Q000295:instrumentation / Q000379:methods*