1. Clinical breast exam. 2. Imaging. 3. Biopsy ELASTOGRAPHY. Triple assessment. Overdiagnosed!?

Transcription

1 Budapest, 2017.

2 Introduction The main purpose of all diagnostic methods is early breast cancer detection However, considering higher incidence of benign lesions comparing to malignant, there is a great importance of noninvasive detection of Benign Breast Diseases (BBD), since most of the benign lesions have not malignant potential

3 2. Imaging 1. Clinical breast exam ELASTOGRAPHY 3. Biopsy Triple assessment Overdiagnosed!?

4 Elastography-definition Sonoelastography is noninvasive, complementary, diagnostic technique that directly reveals soft tissue elasticity. Elasticity assessment: qualitative (Tsukuba elasticity score-tes) semiquantitative evaluation (strain ratio between fat and lesion, SR). *Sensitivity 86.5% % Specificity 76% -89.8% Accuracy 88.3% *Faruk T. Clin Breast Cancer, 2015.

5 Ueno staging-tsukuba score (TES) Elastography-quantitative evaluation A B

6 Objective To detect diagnostic performance of the combined use of sonoelastographic scoring and strain ratio in differentiation of benign and malignant breast lesions and compare it with conventional sonography with the histopathology as the standard reference

7 Method A total of 128 breast lesions (73 malignant and 55 benign) in 125 women (mean age 54 years, range yrs) were enrolled in one year prospective study that was conducted in Clinical Center Bezanijska kosa in Belgrade. Minimum Maximum Medijana X SD Age

8 Method Conventional US and sonoelastography were performed. B-mode images were classified according to the Breast Imaging Recording and Data System. The hardness was determined with 5-point scoring method (Ueno classification) and SR of the lesions were calculated by dividing the strain value of the subcutaneous fat by that of the mass. Receiver operating characteristic (ROC) curves were performed and the cutoff point for differentiation of benign and malignant masses was detected.

9 Final pathological diagnosis Nonproliferative lesions Proliferative lesions without atypia Proliferative lesions with atypia Malignant lesions

10 BI RADS scores of benign and malignant breast lesions Cut-off value benign vs. malignant 4 benign malignant total % 0.0% 3.9% BI RADS classification % 0.0% 5.5% % 21.9% 45.3% % 78.1% 45.3% p< ,0% 100,0% 100,0%

11 Elasticity scores for benign and malignant lesions Benign Malignant Total TES benigni/maligni TES 1, 2, 3 34 (92%) 3 37 TES 4, (77%) 91 Pathological diagnosis benign 4 (7.3%) Elasticity score TES total 7 (12.7%) malignant 0 1 (1.4%) p< (41.8%) 2 (2.7%) 13 (23.6%) 14 (19.2%) 8 (14.5%) 56 (76.7%) total

12 Elastography-TES TES for benign lesions 3.25 TES for malignant lesions 4.71 p<0.001 cut-off value benign/malignant 4 Sensitiivity 95% and specificity 61.8% AUC p CI 95% TES <

13 TES can predict certain type of benign lesions! Xsr SD min Max median Nonproliferative lesions Proliferative lesions without atypia Proliferative lesions with atypia

14 Elastography - SR Benign lesions 9 Malignant lesions 24 p<0.001 cut-off value Sensitivity 97,3%, Specificity 55.6% AUC p CI 95% SR <

15 ROC curve for TES and SR AUC p CI 95% TES < SR TES and SR

16 ROC curve for B-mode ultrasound and TES AUC p CI 95% TES < US TES and US

17 TES 1 LIPOMA

18 TES 2 Cysta mammae

19 Fibroadenoma TES 3 SR 2.54

20 TES 3/SR 5.11 Ca mucinosum TES 5/SR 8.53 Ca mucinosum

21 TES 4 / SR Malignant tumor

22 TES 5 / SR Malignant tumor

23 BGR artefact Cysta mammae

24 CONCLUSION The combined use of elasticity score and strain ratio of sonoelastography increased the diagnostic performance in distinguishing benign from malignant breast masses, but combination of sonography and TES had better diagnostic performance. Sonoelastography has demonstrated to be a promising, complementary, noninvasive technique to detect and evaluate breast lesions, and could potentially reduce the number of unnecessary biopsies. But it needs optimizations in technique, cut off values, coding system, analyzing the effect of depth of the lesion and other parameters that can make influence to elastography exam, etc

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