Transcript Document

ABSTRACT ID .NO: IRIA-1214
TOPIC
ROLE OF ELASTOGRAPHY IN CHARACTERISATION OF
BREAST LESIONS.
INTRODUCTION
 Breast cancer is the most common malignancy in women .
 The early breast cancer detection modalities such as
mammography ,ultrasonography and magnetic resonance imaging
have high sensitivity but low specificity.
 Due to overlapping sonographic features of some benign and
malignant lesions, biopsies become inevitable causing discomfort
to the patients and increased costs.
 To overcome these limitations, ultrasound elastography was
introduced which has high specificity in characterization of breast
lesions
MATERIALS AND METHODS
 PATIENTS:
Breast lesions of 26 patients were analyzed by B mode ultrasound and three
modes of elastography namely esie touch, virtual touch tissue imaging, virtual
touch tissue quantification.
 TECHNIQUE:
Sonographic and elastographic examinations were performed by using the
ACUSON S2000 ultrasound system(siemens medical solutions, mountain view,
CA,USA)with a band width of 4-9 MHZ with an integrated elastography
software and ARFI technology.
ESIE TOUCH
Score1:Even strain for the entire lesion
simple cyst
Score2:Strain in most of the lesion with
some areas of no strain(mosaic pattern)
FNAC: Fibro adenoma
Score3:Strain at the periphery of the lesion
with sparing of the center
HPE: Fibro epithelial lesion
Score4:No strain in the entire lesion
HPE: Fibro adenoma with hyalinization
score5:No strain in the entire lesion and
surrounding area.
HPE: Infiltrating ductal carcinoma
ARFI(VTI)
Bright -cyst
Intermediate-Fibro adenoma
Dark - carcinoma
BENIGN LESION
SHEAR WAVE
VELOCITIES
WITHIN THE LESION
BORDER
GLANDULAR TISSUE
FAT
MALIGNANT LESION
DISCUSSION
 Ultrasound elastography estimates the relative tissue stiffness in response to a
stressing force
 ESIE TOUCH :
In our study esie touch is performed by a very light compression
with the probe.
 Elastographic images were assessed by a color scale

Red :the areas with no strain

Green :to areas with intermediate elasticity

Blue: to components with the greatest strain.
 Images were classified according to the 5 score system of Ueno and colleagues;

Score1-Even strain for the entire lesion

Score2-Strain in most of the lesion with some areas of no strain(mosaic pattern)

Score3-Strain at the periphery of the lesion with sparing of the center

Score4-No strain in the entire lesion

Score5-No strain in the entire lesion and surrounding area.
 It is subjective and operator dependent
DISCUSSION

ARFI
: Composed of two components
 VIRTUAL TOUCH TISSUE IMAGING: By using acoustic radiation forces ,to
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generate localised tissue displacements it generates a qualitative map depicting the
relative stiffness of tissue.
1.stiff tissue appear dark
2.soft tissues appear bright
VIRTUAL TOUCH TISSUE QUANTIFICATION:
It quantifies the absolute tissue elasticity
Calculates the propagation velocity of the shear waves through tissues induced by
focused radiation force
The limits for measurements of VTQ values for this machine were 0-9m/s
The values outside these limits were displayed as X.XX.
Stiffer tissues will have more shear wave velocities compared to softer tissues
EXCEPTIONS:
Soft malignant lesions such as mucinous, medullary, papillary and some infiltrating
ductal carcinomas.
Hard benign lesions, Hyalinised fibro adenomas and fat necrosis.
RESULTS
Esie touch- strain elastography
ARFI -VTI
2
ESIE TOUCH 2
12
9
ESIE TOUCH 3
11
12
VTI BENIGN DARK
ESIE TOUCH 4
VTI BENIGN INTERMEDIATE
ESIE TOUCH 5
3
All malignant lesions showed score 5
and benign lesions showed scores
2,3,and 4 on esie touch depending on
the degree of hardness
VTI CARCINOMA DARK
3
All malignant lesions in our study showed
dark elastogram on VTI.
Out of 14 benign lesions 11,showed
intermediate and 3 showed dark elastogram
which may be due to hard lesions or due to
excessive compression resulting in false
positives.
SHEAR WAVE VELOCITIES
1.049286
2.987322842
6.348462
L
B
3.884182114
5.5016134
MALIGNANT LESIONS
3.320714
B
1.810714
G
G
F
F
2.339286
BENIGN LESIONS
• Average shear wave velocities are higher with in the lesion compared to
the border, which are in turn higher compared to the glandular tissue and
fat respectively for both benign and malignant lesions.
•
L
These values are higher for malignant lesions compared to the benign
lesions.
MALIGNANT
LESIONS
B Mode Ultrasound &
Doppler
After elastography
2
Birads V
Birads IV
10
Birads V
12
Out of the 12 malignant lesions 2 of the BIRADS-IV
category lesions were correctly upgraded to BIRADS V
after using elastography
BENIGN LESIONS
B mode ultrasound
After elastography
2
5
Birads III
9
BiradsIII
Birads IV
BiradsIV
12
Out of the 14 malignant lesions 4 of the BIRADS-IV category
lesions were correctly downgraded to BIRADS -III after
using elastography. Two of the lesions showed false positive
results as one was a hyalinized fibroadenoma and another
was sclerosing intraductal papilloma.
CONCLUSION
 Addition of Elasticity imaging was useful because it
corroborated better with histopathology and
increased our confidence levels in characterization of
breast lesions and reduced the need for biopsies.
 ACR BIRADS ATLAS Vth EDITION has added
elasticity assessment as a parameter in the associated
features unlike the previous editions.
RFERENCES
 Beatriz Navarro, MD, Belen Ubeda , MD, Merce
Vallespi, MD, Casandra Wolf, MD, Lilian Casas, MD,Jean
L.Browne, MD
 WEI MENG,GUANGCHEN ZHANG,CHANGJUN
WU,GUOZHU WU,YAN SONG,ZHAOLING LU
 Ultrasound department,The first affiliated Hospital of
Harbin Medical University ,Harbin,China;and Technology
Department ,Siemens of Chindex International Inc.,China
 Jianqiao zhou, MD,Weiwei zhan, MD,Cai Chang ,MD,
Jinwen zhang,MD, Zhifang,MD,Yijie Dong, MD,Chun
Zhou,MD,Yanyan Song,phD