- Volume 17 Issue 5
DOI QR Code
Ultrasound Breast Elastographic Evaluation of Mass-Forming Ductal Carcinoma-in-situ with Histological Correlation - New Findings for a Toothpaste Sign
- Leong, Lester Chee Hao (Diagnostic Radiology, Radiology, Singapore General Hospital) ;
- Sim, Llewellyn Shao-Jen (Diagnostic Radiology, Radiology, Singapore General Hospital) ;
- Jara-Lazaro, Ana Richelia (Quintiles East Asia Pte Ltd.) ;
- Tan, Puay Hoon (Department of Pathology, Singapore General Hospital)
- Published : 2016.05.01
Background: It is unclear as to whether the size ratio elastographic technique is useful for assessing ultrasound-detected ductal carcinoma-in-situ (DCIS) masses since they commonly lack a significant desmoplastic reaction. The objectives of this study were to determine the accuracy of this elastographic technique in DCIS and examine if there was any histopathological correlation with the grey-scale strain patterns. Materials and Methods: Female patients referred to the radiology department for image-guided breast biopsy were prospectively evaluated by ultrasound elastography prior to biopsy. Histological diagnosis was the gold standard. An elastographic size ratio of more than 1.1 was considered malignant. Elastographic strain patterns were assessed for correlation with the DCIS histological architectural patterns and nuclear grade. Results: There were 30 DCIS cases. Elastographic sensitivity for detection of malignancy was 86.7% (26/30). 10/30 (33.3%) DCIS masses demonstrated predominantly white elastographic strain patterns while 20/30 (66.7%) were predominantly black. There were 3 (10.0%) DCIS masses that showed had a co-existent bull's-eye sign and 7 (23.3%) other masses had a co-existent toothpaste sign, a strain pattern that has never been reported in the literature. Four out of 4/5 comedo DCIS showed a predominantly white strain pattern (p=0.031) while 6/7 cases with the toothpaste sign were papillary DCIS (p=0.031). There was no relationship between the strain pattern and the DCIS nuclear grade. Conclusions: The size ratio elastographic technique was found to be very sensitive for ultrasound-detected DCIS masses. While the elastographic grey-scale strain pattern should not be used for diagnostic purposes, it correlated well with the DCIS architecture.
Breast cancer;carcinoma-in-situ;elastographic evaluation;novel toothpaste sign
- Barr RG, Campbell, Grajo JR (2008). Sensitivity and specificity of the bull's-eye artifact on breast elastography imaging to characterize cysts. 2008 RSNA Scientific Assembly.
- Chang JM, Won JK, Lee KB, et al (2013). Comparison of shear-wave and strain ultrasound elastography in the differentiation of benign and malignant breast lesions. AJR Am J Roentgenol, 201, 347-6. https://doi.org/10.2214/AJR.12.9451
- Dershaw DD, Abramson A, Kinne DW (1989). Ductal carcinoma in situ: Mammographic findings and clinical implications. Radiology, 170, 411-5. https://doi.org/10.1148/radiology.170.2.2536185
- Garra BS, Cespedes EI, Ophir J, et al (1997). Elastography of breast lesions: initial clinical results. Radiol, 202, 79-6. https://doi.org/10.1148/radiology.202.1.8988195
- Gwak YJ, Kim HJ, Kwak JY, et al (2011). Ultrasonographic detection and characterization of asymptomatic ductal carcinoma in situ with histopathologic correlation. Acta Radiol, 52, 364-1. https://doi.org/10.1258/ar.2011.100391
- Hall T, Svensson W, Von Behren P, et al (2003). Lesion Size Ratio for Differentiating Breast Masses. IEEE Ultrasonics Symposium, 2, 1247-0.
- Ikeda DM, Andersson I (1989). Ductal carcinoma in situ: Atypical mammographic appearances. Radiol, 172, 661-6. https://doi.org/10.1148/radiology.172.3.2549563
- Itoh A, Ueno E, Tohno E, et al (2006). Breast disease: clinical application of US elastography for diagnosis. Radiol, 239, 341-0. https://doi.org/10.1148/radiol.2391041676
- Kuhl CK, Schrading S, Bieling HB, et al (2007). MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet, 370, 485-2. https://doi.org/10.1016/S0140-6736(07)61232-X
- Lakhani, SR, Ellis, IO, Schnitt SJ, Tan PH, van de Vijver M (2012). World Health Organisation Classification of Tumours of the Breast, IARC, Lyon.
- Leong LC, Sim LS, Lee YS et al (2010). A prospective study to compare the diagnostic performance of breast elastography versus conventional breast ultrasound. Clin Radiol, 65, 887-4. https://doi.org/10.1016/j.crad.2010.06.008
- Lester S (2010). Manual of surgical pathology. 3rd edition. in: breast. philadelphia: saunders. 262-8.
- Matsumura T, Tamano S, Shinomura R, et al (2004). Preliminary evaluation of breast disease diagnosis based on real-time elasticity imaging. In proceedings of the third international conference on the ultrasonic measurement and imaging of tissue elasticity. Lake Windermere: Cumbria, United Kingdom, 17e20, 023.
- Moon WK, Myung JS, Lee YJ, et al (2002). US of ductal carcinoma in situ. Radiographics, 22, 269-0. https://doi.org/10.1148/radiographics.22.2.g02mr16269
- Stomper PC, Connolly JL, Meyer JE, et al (1989). Clinically occult ductal carcinoma in situ detected with mammography: Analysis of 100 cases with radiologic-pathologic correlation. Radiol, 172, 235-1. https://doi.org/10.1148/radiology.172.1.2544922
- Sohn YM, Kim MJ, Kim EK, et al (2009). Sonographic elastography combined with conventional sonography: how much is it helpful for diagnostic performance? J Ultrasound Med, 28, 413-0. https://doi.org/10.7863/jum.2009.28.4.413
- Tan SM, Teh HS, Mancer JF, Poh WT (2008). Improving B mode ultrasound of breast lesions with real-time ultrasound elastography: a clinical approach. Breast, 17, 252-7. https://doi.org/10.1016/j.breast.2007.10.015
- Uematsu T (2012). Non-mass-like lesions on breast ultrasonography: a systematic review. Breast Cancer, 19, 295-1. https://doi.org/10.1007/s12282-012-0364-z
- Vinnicombe SJ, Whelehan P, Thomson K, et al (2014). What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography? Eur Radiol, 24, 921-6. https://doi.org/10.1007/s00330-013-3079-4