Open AccessCombination of shear-wave elastography and color Doppler: Feasible method to avoid unnecessary breast excision of fibroepithelial lesions diagnosed by core needle biopsy
Author(s) -
Ga Ram Kim,
Ji Soo Choi,
BooKyung Han,
Eun Young Ko,
Soo Yeon Hahn
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0175380
Subject(s) - elastography , doppler effect , core biopsy , biopsy , medicine , radiology , color doppler , shear (geology) , ultrasonography , physics , breast cancer , materials science , ultrasound , astronomy , cancer , composite material
Background We evaluated shear-wave elastography (SWE) and color Doppler ultrasonography (US) features for fibroepithelial lesions (FELs), and to evaluate their utility to differentiate fibroadenomas (FAs) and phyllodes tumors (PTs). Methods This retrospective study included 67 FELs pathologically confirmed (49 FAs, 18 PTs). B-mode US, SWE and color Doppler US were performed for each lesion. Mean elasticity (E mean ), maximum elasticity (E max ), and vascularity were determined by SWE and Doppler US. Diagnostic performances were calculated to differentiate FAs and PTs. Equivocal FELs diagnosed by core needle biopsy (CNB) were further analyzed. Results Median E mean and E max were significantly lower for FAs than PTs (E mean , 15.7 vs. 66.7 kPa; E max , 21.0 vs. 76.7 kPa, P<0.01). Low vascularity (0–1 vessel flow) on color Doppler US were more frequent in FAs than in PTs ( P <0.01). SWE showed significantly higher specificities (E mean >43.9 kPa, 89.8%; E max >46.1 kPa, 79.6%) than B-mode US (42.9%) ( P <0.01) for differentiating PTs from FAs. Other diagnostic values of SWE and overall diagnostic values of Doppler US were not significantly different from B-mode US ( P >0.05). The combination of SWE and Doppler US with ‘E mean >43.9 kPa or high vascularity (≥2 vessel flows)’ showed a higher area under the curve (0.786 vs. 0.687) and higher diagnostic values than B-mode US (sensitivity, 100 vs. 94.4%; specificity, 57.1 vs. 42.9%; positive predictive value, 46.2 vs. 37.8%; negative predictive value, 100 vs. 95.5%), without statistical significance ( P >0.05). Of the 30 equivocal FELs, all lesions with ‘E mean ≤43.9 kPa and low vascularity (0–1 vessel flow)’ (23.3%, 7/30) were finally confirmed as FAs by excision. Conclusion FAs have a tendency to have less stiffness and lower vascularity than PTs. Combined SWE and color Doppler US may help patients with equivocal FELs diagnosed by CNB avoid unnecessary excision.