title: Ultrasound Strain Elastography for Breast Lesions: Computer-Aided Evaluation With Quantifiable Elastographic Features.
abstract: OBJECTIVE
  To develop and evaluate a set of quantifiable elastographic features based on ultrasound real-time strain elastography (SE) in differentiating between benign and malignant breast lesions.
  
  
  METHODS
  The SE and conventional B-mode ultrasound images of 226 breast lesions (81 malignant, 145 benign) were obtained from 226 consecutive women. By using a computer-aided tool, four elastographic features (elasticity score, lesion stiffness degree, lesion-to-fat strain ratio, and elastography-to-B-mode lesion area ratio) were respectively calculated and evaluated. Histopathologic results were used as the reference standard. B-mode Breast Imaging Reporting and Data System categorization was used to compare the performances between B-mode ultrasound and SE. Sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic curve analyses were performed to evaluate the diagnostic performances for three data sets (conventional B-mode ultrasound alone, SE features alone, combined SE features).
  
  
  RESULTS
  Quantifiable SE features for malignant lesions all showed significantly higher values than those for benign lesions (all P < .001). The evaluation with any individual SE feature significantly improved the specificity in breast lesion differentiation compared with B-mode ultrasound (all P <.001). The logistic regression model combing SE features significantly improved the diagnostic performance compared with B-mode US, with significantly increased specificity (95.2% versus 54.5%; P < .001) and area under the receiver operating characteristic curve (0.988 versus 0.921, P < .001).
  
  
  CONCLUSIONS
  Computer-aided tool with SE provided further elasticity information for breast characterization. Evaluation using quantifiable SE features showed better diagnostic performance than conventional B-mode ultrasound in breast lesion differentiation.
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zeng
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Niu
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Qian
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: Cong-Zhi
authors.initials: CZ
authors.lastname: Wang
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: Hai-Rong
authors.initials: HR
authors.lastname: Zheng
authors.affiliation: Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
authors.forename: Rong-Qin
authors.initials: RQ
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D055815:Young Adult
keywords: breast; computer-aided; quantifiable elastographic features; ultrasound real-time strain elastograhpy