The role of real time elastography in breast lesions

Purpose: To evaluate the contribution of elastography in benign-malignant discrimination of solid breast lesions and to investigate whether it has a role in determination of tumor invasion in peripheral breast tissue in case of malignancy.Materials & Method: All patients, who were found to have solid breast lesions in our Breast Imaging Department (June 2010 ? June 2011), were enrolled in this prospective study. Informed and signed consent were obtained from all participants. 171 patients who had a solid lesion necessitating biopsy and had histo-pathological results constituted the study population. BI-RADS classification, elastographic score and histo-pathological results of these cases were recorded. Gray-scale ultrasonography and elastography findings were compared with histo-pathological diagnosis to assess the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy. In addition, elastography findings of the peripheral breast tissue were also correlated to histo-pathological findings.Results: 179 lesions in 171 patients were evaluated. Average lesion diameter was 16,8 mm (range: 5-50 mm). According to elastography results, 77 lesions had elastography scores 1-3, remaining 102 lesions had scores 4-5. At histo-pathological evaluation, 98 lesions were benign and 81 lesions were malignant. Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of gray-scale ultrasonography were 97%, 58%, 66%, 96% and 76%, respectively. Same figures were calculated for real time elastography as following: 97%, 76%, 77%, 97% and 86%, respectively. There was a statistically significant relationship between the histo-pathological results and elastography imaging, regarding the malignant findings and/or fibrosis in the peripheral breast tissue in case of elastography score 5 malignant lesions (k=0,625).Discussion: Real time elastography is a novel improvement of ultrasonography, which has a substantial contribution in benign-malignant discrimination of solid lesions. The results of the presented study are also congruent with the literature. The ability to determine benign lesions is an especially important issue to decrease unnecessary biopsy rates.Key words: solid breast mass, real time elastography, tumor invasion