This small study suggests that adding a special analysis -- called elastography -- to breast ultrasound can help doctors decide if a breast mass is cancer and needs to be biopsied.
If a breast mass shows up on a mammogram, doctors often do a breast ultrasound to help them see other characteristics of the mass -- how solid it is or whether it has fluid in it, for example -- that show better in an ultrasound. Having all this information can help doctors decide if the mass is cancer and if a biopsy makes sense. If the mass appears to be benign (not cancer) based on the ultrasound, careful monitoring of the mass without a biopsy could make sense.
A breast biopsy is an invasive procedure, so doctors only want to do it when it's necessary. The researchers who did this study estimated that 80% of biopsied breast masses turn out to be benign. Having a better way to figure out if a mass is likely to be cancer could help women avoid unnecessary biopsies.
Elastography uses a computer program to analyze ultrasound images of a breast mass and judge how stiff the mass is. An ultrasound done with elastography is no different than that one done without elastography. Masses that are cancer tend to be stiffer than the surrounding healthy breast tissue. The elastography software judges stiffness of a mass by detecting how much the mass does or doesn't get compressed by the pressure of breathing, heart beats, or by pushing on the chest wall.
All the masses in this study were biopsied.
The researchers found:
These results suggest that elastography is better at judging when a mass is cancer than it is at judging when a mass is benign.
Elastography software isn't new, but hasn't been used very much to help diagnose breast cancer. The results of this study suggest that using elastography more often during breast ultrasound could help doctors decide if a breast mass should be biopsied and help avoid some unnecessary breast biopsies.
The Breastcancer.org Ultrasound page has more information about when and how breast ultrasound in done and how the results help doctors diagnose benign and cancerous breast masses.
CHICAGO (MedPage Today) -- Adding elastography to breast ultrasound may help distinguish between cancerous and benign results, potentially decreasing the need for biopsies, researchers said here.
The imaging test, which looks at the stiffness of tissue, correctly identified 98% of cancerous lesions and 78% of those that weren't cancerous in a trial of about 200 patients, Stamatia V. Destounis, MD, of Elizabeth Wende Breast Care in Rochester, N.Y., reported at the Radiological Society of North America meeting.
"Addition of elastography could potentially help decrease the need to perform biopsy or reduce the need for additional imaging of benign lesions," Destounis said.
Ultrasound is often used after mammography to investigate suspicious findings, but it tends to result in more biopsies because of its relatively low specificity, she explained.
In fact, 80% of biopsied breast lesions turn out to be benign.
But adding elastography -- which is simply a matter of adding or activating software during an ultrasound -- may improve correct diagnosis. It uses pressure from breathing, heartbeat, or pushing on the skin to examine the compressibility of a lesion.
"A malignant tumor will be stiffer than surrounding normal breast tissue," Destounis said, explaining that a non-cancerous lesion will compress better and look smaller on a scan.
She said elastography is not a new technology, but it is undergoing somewhat of a resurgence. It can be used in situations that deal with soft tissue, such as breast and thyroid imaging.
To assess the sensitivity and specificity of the procedure, the researchers examined 193 patients at their center who had breast ultrasound and elastography, for a total of 198 elastograms.
They performed biopsies on all solid lesions.
Of 140 biopsies, 59 were cancerous, and elastography correctly identified 98% of them, Destounis said.
Among the 69 lesions that turned out to be benign, elastography correctly identified 78% of them.
"The specificity is not as good as it was for the cancerous lesions," Destounis said. Still, she added that elastography may be a means of reducing pain and anxiety from biopsies after suspicious findings on mammograms.
"With more research," she said, "elastography could impact decisions to not perform biopsy in patients [who don't need it]."
Although it may be an additional tool for cancer detection, it probably won't completely replace needle biopsy, Destounis added.
"You still have patients who insist on needle biopsy because they don't want to worry at all," she said. "But it's exciting that we are trying to find ways to not perform unnecessary biopsies."
Destounis reported being a research consultant for Carestream Health, being on the Medical Advisory Board of and an an investigator for Siemens AG, and an investigator for FUJIFILM, Hologic, and U-Systems, Inc.
Two co-authors reported being investigators for FUJIFILM, Koning, and Hologic.
Primary source: Radiological Society of North America Source reference: Destounis S, et al "The Role of Elasticity Imaging (EI) in a Large Community-based Breast Imaging Center" RSNA 2009; Abstract LL-BR4059-B04.
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