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Virtual touch tissue imaging and quantification: value in malignancy prediction for complex cystic and solid breast

Ying Zhang1,2, Chong-Ke Zhao1, Xiao-Long Li1

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Combining conventional ultrasound with advanced elastography significantly improves malignancy prediction in complex breast lesions. This enhanced diagnostic approach boosts specificity without compromising sensitivity, aiding clinical decision-making.

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Area of Science:

  • Radiology and Medical Imaging
  • Oncology
  • Biomedical Engineering

Background:

  • Accurate differentiation of benign from malignant complex cystic and solid breast lesions is crucial for effective patient management.
  • Conventional ultrasound (US) has limitations in characterizing these lesions, necessitating advanced imaging techniques.
  • Ultrasound elastography offers complementary information on tissue stiffness, potentially improving diagnostic accuracy.

Purpose of the Study:

  • To evaluate the diagnostic performance of conventional US and various US elastography techniques in predicting malignancy of complex cystic and solid breast lesions.
  • To assess the added value of US elastography, including virtual touch tissue imaging and quantification (VTIQ), to conventional US for malignancy prediction.

Main Methods:

  • Eighty-nine complex cystic and solid breast lesions were examined using conventional US and US elastography (strain elastography, VTI, VTIQ).
  • Multivariate logistic regression analysis identified independent predictors of malignancy.
  • Receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficacy of conventional US alone versus combined with US elastography.

Main Results:

  • Independent predictors for malignancy included VTI pattern 4b, non-circumscribed lesion margins, high shear wave speed (SWS) mean in VTIQ, and patient age over 50.
  • Combining conventional US with US elastography significantly increased the area under the ROC curve (Az) from 0.649 to 0.918 (p < 0.0001).
  • The combined method substantially improved specificity (32.7% to 87.3%, p < 0.0001) while maintaining high sensitivity (97.1% to 85.3%, p = 0.075).

Conclusions:

  • Both conventional US and US elastography are valuable tools for malignancy prediction in complex breast lesions.
  • Integrating US elastography, particularly VTIQ, with conventional US significantly enhances diagnostic performance, especially specificity.
  • This combined approach offers improved accuracy for differentiating benign from malignant complex cystic and solid breast lesions.