CHICAGO - Elastography has the potential to reduce unnecessary biopsies, according to a study presented at the RSNA meeting on Sunday.
Researchers from Elizabeth Wende Breast Care in Rochester, NY, found a correlation of 98% between elastography, standard ultrasound, clinical mammography, and biopsy for cancerous lesions. For benign lesions, although the percentage was a bit lower at 78%, elastography could still help clinicians decide whether biopsy is needed.
"We see a lot of young women in our center who've felt a lump and come in to have it checked out," said the study's lead author, Dr. Stamatia Destounis. "Typically, these are fibroadenomas, and if we trust elastography, we don't need to perform biopsies for lesions like that. We can avoid unnecessary testing."
Elastography improves ultrasound's specificity by using conventional ultrasound to measure the compressibility and mechanical proportions of a lesion. The idea is that because cancer tissue tends to be stiffer than healthy tissue, if a lesion is compressible it's less likely to be malignant. The technique's measurements for cancerous lesions tend to be smaller than ultrasound's, and its measurements for benign lesions tend to be larger than ultrasound's, Destounis said.
The researchers used a Sonoline Antares in the beginning of the study, before upgrading to an Acuson S2000 unit (both from Siemens Healthcare, Erlangen, Germany). Between 2008 and 2009, an elastography exam was given at the same time as a hand-held ultrasound exam to 193 patients with 198 lesions. All solid lesions had some form of needle aspiration. Destounis and colleagues compared standard B-mode ultrasound, elastography, cine loops, and color mapping, and collected data for the following:
- B-mode lesion size
- Elastography lesion size
- Percentage likelihood of malignancy, based on 2D ultrasound versus elastography
- Lesion ratios (side to side, top to bottom)
The team performed 140 biopsies. Out of those 140 biopsies, 59 cancers were found, according to Destounis.
"We were able to show concordance between B-mode, elastography, and needle biopsy in 98% of those cancer cases," she said.
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| 46-year-old patient presents for evaluation of left breast nodule after being recalled from screening mammography. Above, mammogram: Nodule present within the left central aspect. Below, B-mode and elastography: Ultrasound shows a cyst present corresponding to area noted on mammogram. Elastography image demonstrates the "bull's-eye" appearance of cysts on elastography. A cyst aspiration was performed and the cyst resolved. Images courtesy of Dr. Stamatia Destounis. |
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No consensus yet
Despite these positive results, not everyone agrees that elastography is trustworthy enough at this point in its development. In another Sunday presentation, Korean researchers described a study they had conducted with 284 women with 342 sonographically visible breast lesions scheduled for biopsy between December 2007 and December 2008. They also used Siemens' Sonoline Antares, and compared elastography's ability to characterize lesions with that of conventional ultrasound.
Dr. Jin Hwa Lee from Dong-A University in Busan, South Korea, and colleagues found that elastography's specificity was 83.3%, compared to 28.4% for B-mode ultrasound. But its sensitivity was far lower at 77.4%, compared to 98.8% sensitivity for B-mode, leading the researchers to conclude that the technology's advantages may not overcome the risk of missed cancer.
The differing results are probably due to elastography's ongoing refinement, Destounis said. She estimates that the technique will go mainstream -- as a built-in addition to future ultrasound units -- over the next four to five years.
"Elastography is definitely not the end-all-be-all," she said. "It's another tool, and you don't decide not to biopsy something just because of elastography results -- you have to use all the clinical information that you have. The technology is progressing, with multiple vendors trying to perfect it. It's a developing technique."
By Kate Madden Yee
AuntMinnie.com staff writer
November 30, 2009
Related Reading
Elastography shines in assessing breast lesions, April 29, 2009
Adding sonography to yearly mammograms helps find metachronous cancers, February 25, 2008
Breast sonoelastography aids in evaluating breast lesions, January 28, 2008
Elasticity imaging finds breast tumors based on shape, volume, December 14, 2007
Copyright © 2009 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
