1. BREAST ELASTOGRAPHY AND POWER DOPPLER VOCAL FREMITUS SONOGRAPHY (PDVF)
A Technologist’s Point of View
Lisa Smith, Nancy Infusini,
Nicoleta Miclea Miron, Martine Paré
Cedars Breast Clinic

2. Disclosure Statement: No Conflict of Interest
I do not have an affiliation, financial or otherwise, with a pharmaceutical company, medical device or communications organization.
I have no conflicts of interest to disclose ( i.e. no industry funding received or other commercial relationships).
I have no financial relationship or advisory role with pharmaceutical or device-making companies, or CME provider.
I will be discussing the results of ____ (“off-label” use), which is currently classified by Health Canada as investigational for the intended use.
I will not discuss or describe in my presentation at the meeting the investigational or unlabeled ("off-label") use of a medical device, product, or pharmaceutical that is classified by Health Canada as investigational for the intended use.
May 28 – 30, 2015, Montréal, Québec

3. THE CEDARS BREAST CLINIC TEAM

4. OBJECTIVES BREAST ANATOMY WHAT IS ELASTOGRAPHY TYPES OF ELASTOGRAPHY
ELASTOGRAPHY MAPS
WHAT IS POWER DOPPLER VOCAL FREMITUS (PDVF)
THE EFFECTS OF THE APPLICATIONS
EXAMPLES OF DIFFERENT LESIONS

5. ANATOMY OF THE BREAST

6. BREAST TYPES
DENSE BREAST

7. GLANDULAR BREAST TISSUE

8. FATTY BREAST TISSUE

9. BREAST FEEDING

10. CHARACTERISTICS OF MASSES
Benign
SHAPE(round, oval)
MARGIN (well circumscribed ,)
ECHO PATTERN (anechoic isoechogenic , hyperechogenic)
Posterior enhancement
Malignant
SHAPE (irregular)
MARGIN (spiculated, indistinct, angular)
ECHO PATTERN (hypo echogenic )
Posterior shadowing

11. WORRISOME SIGNS
Shape
Orientation
Contours
Transmission

12. LACK OF WORRISOME SIGNS BENIGN SIGNS ?
Shape
Orientation
Contours
Transmission

13. ELASTOGRAPHY ?
Application introduced to differentiate different types of breast tissues, i.e. benign lesions, (soft tissues) and malignant lesions (hard tissues).

14. WHAT IS ELASTOGRAPHY ?
It’s the difference in elasticity of different tissues.
It’s the deformation of the tissue
Implement young’s modulus theory

15. ELASTICITY
Young’s modulus = elasticity modulus
Constant E
E =

16. TYPES OF ELASTOGRAHPY CONVENTIONAL STRAIN Gray scale
Computer algorithm
Operator induces force/compress
Probe 12mhz, 8mhz
Map colour scale

17. STRAIN IMAGING COMPRESSION ELASTOGRAPHY
Compare the image before and after compression
Compare with adjacent structure
Algorithm code in colour or Grey

18. FIBROADENOMA

19. COLOUR MAP OF A FIBROADENOMA

20. THE RATIO IS 2.0

21. ELASTOGRAPHY OF A CYST

22. ELASTOGRAPHY OF A FIBROADENOMA

23. SHEAR WAVE
COLOUR MAP 2D
QUANTITATIVE MEASUREMENT (max, mean and SD) kPa(180)
PROBE : Conventional Linear Array.
Radiated force induced by probe.
Optional : play with resolution for small and cystic lesions play with penetration for deep and large lesions.

24. Step One Step Two Step Three

25. SHEAR WAVE IMAGING Total duration = 20msec Step 1 Step 2 Step 3
Shear waves generated by sending a long focused pulse into the tissue:
Step 2
Ultrafast Imaging
Step 3
Processing
Total duration = 20msec 25

26. ELASTOGRAPHY OF A FIBROCYSTIC LESION

27. ELASTOGRAPHY OF A MASS

28. COMPARISON OF SOFT AND HARD LESION. FALSE NEGATIVE
It is stated that benign lesions are soft and malignant lesions are hard. But there are exceptions.
A palpable area biopsied , the result was fibrous breast tissue. Some cancers are soft hyper echogenic, like (mucinous carcinomas) and like scars are hard.

29. PALPABLE NODULE

30. DIFFERENCES Shear wave Conventional quantitative measurement
No compression
Conventional linear array probe
Time frame is faster (20ms)
Conventional
Gray scale and strain
Computer assisted
operator induces pressure

31. LIMITATIONS
Shear wave; Fatty breast with deep lesions. Mobile lesions, Breast implants
Conventional: Breast implants, Deep lesions, superficial lesions, Mobile lesions, small lesions, Excessive pressure

32. ELASTOGRAGHY OF A BREAST IMPLANT

33. POWER DOPPLER VOCAL FREMITUS (PDVF)
Technique using artifacts
Differentiates normal tissue from a lesion,
Outlines the contour of nodules,
Technique using phonation via the thoracic wall Humming

34. PDVF OF A FIBROADENOMA

35. PDVF OF A PAPILOMA

36. PDVF OF A CALCIFIED FIBROADENOMA

37. PDVF OF A CYSTIC AREA

38. ELASTOGRAPHY OF A MASS AND PDVF

39. PDVF

40. STRAIN ELASTO OR TISSUE STRAIN

41. COLOUR MAP OF THE MASS

42. THE ELASTO RATIO IS 6.34

43. VIDEO OF THE LESION

44. VIDEO OF THE CLIP PLACEMENT

45. TOMOSYNTHESIS

46. ? COLOR MAP FOR STRAIN & SHEAR ELASTO Benign : 1-2 ? Category : 3É N I M A L 1 2 3 4 5
Shear wave
[Itoh A, 2006]
Strain Elasto [1-5]
Benign : 1-2
? Category : 3
Malignant : 4 ?

47. FIBROADENOMA

48. THE RELATION TO THE COLOUR MAP OF STRAIN ELASTOGRAGHY

49. THE RATIO IS 1.1 (BENIGN)

50. THE CORRELATION OF ULTRASOUND AND MRI

51. CONTRAST ENHANCING LESION RIGHT BREAST ON MRI, PRONE

52. SAGITTAL MRI DELAYED CONTRAST, RIGHT BREAST

53. ULTRSOUND OF THE LESION

54. PDVF

55. STRAIN ELASTOGRAGHY OF THE LESION

56. GREY SCALE

57. THE ELASTOGRAPHY RATIO IS 35.

58. IMPORTANCE OF ELASTOGRAPHY WITH SECOND LOOK ULTRASOUND

59. 6 Autres Indications
SCFR

60. OTHER INDICATIONS
Lundi 29 octobre 2012 60

61. OTHER INDICATIONS
Lundi 29 octobre 2012
SCFR

62. LIMITS

63. LIMITS

64. LIMITS B É N I M A L 1 2 3 4 5

65. CONCLUSION
Elastography, Power Doppler Vocal Fremitus ( PDVF) ultrasound along with Mammography, Magnectic resonance and Tomosynthesis can assist in the detection of lesions.
The radiologist will use the findings to assign a BI-RADS classification ( Breast imaging report and data system) (ACR).

66. THANK YOU