1. ROLE OF ELASTOGRAPHY IN CHARACTERISATION OF BREAST LESIONS.
ABSTRACT ID .NO: IRIA-1214
TOPIC
ROLE OF ELASTOGRAPHY IN CHARACTERISATION OF BREAST LESIONS.

2. INTRODUCTION Breast cancer is the most common malignancy in women .
The early breast cancer detection modalities such as mammography ,ultrasonography and magnetic resonance imaging have high sensitivity but low specificity.
Due to overlapping sonographic features of some benign and malignant lesions, biopsies become inevitable causing discomfort to the patients and increased costs.
To overcome these limitations, ultrasound elastography was introduced which has high specificity in characterization of breast lesions

3. MATERIALS AND METHODS PATIENTS:
Breast lesions of 26 patients were analyzed by B mode ultrasound and three modes of elastography namely esie touch, virtual touch tissue imaging, virtual touch tissue quantification.
TECHNIQUE:
Sonographic and elastographic examinations were performed by using the ACUSON S2000 ultrasound system(siemens medical solutions, mountain view, CA,USA)with a band width of 4-9 MHZ with an integrated elastography software and ARFI technology.

4. ESIE TOUCH simple cyst Score1:Even strain for the entire lesion
Score2:Strain in most of the lesion with some areas of no strain(mosaic pattern)
FNAC: Fibro adenoma
Score3:Strain at the periphery of the lesion with sparing of the center
HPE: Fibro epithelial lesion
Score4:No strain in the entire lesion
HPE: Fibro adenoma with hyalinization
score5:No strain in the entire lesion and surrounding area.
HPE: Infiltrating ductal carcinoma

5. ARFI(VTI)
Bright -cyst
Intermediate-Fibro adenoma
Dark - carcinoma

6. SHEAR WAVE
VELOCITIES
BENIGN LESION
MALIGNANT LESION
WITHIN THE LESION
BORDER
GLANDULAR TISSUE
FAT

7. DISCUSSION
Ultrasound elastography estimates the relative tissue stiffness in response to a stressing force :
In our study esie touch is performed by a very light compression
with the probe.
Elastographic images were assessed by a color scale
Red :the areas with no strain
Green :to areas with intermediate elasticity
Blue: to components with the greatest strain.
Images were classified according to the 5 score system of Ueno and colleagues;
Score1-Even strain for the entire lesion
Score2-Strain in most of the lesion with some areas of no strain(mosaic pattern)
Score3-Strain at the periphery of the lesion with sparing of the center
Score4-No strain in the entire lesion
Score5-No strain in the entire lesion and surrounding area.
It is subjective and operator dependent
ESIE TOUCH

8. DISCUSSION
ARFI
: Composed of two components
VIRTUAL TOUCH TISSUE IMAGING: By using acoustic radiation forces ,to generate localised tissue displacements it generates a qualitative map depicting the relative stiffness of tissue.
1.stiff tissue appear dark
2.soft tissues appear bright
VIRTUAL TOUCH TISSUE QUANTIFICATION:
It quantifies the absolute tissue elasticity
Calculates the propagation velocity of the shear waves through tissues induced by
focused radiation force
The limits for measurements of VTQ values for this machine were 0-9m/s
The values outside these limits were displayed as X.XX.
Stiffer tissues will have more shear wave velocities compared to softer tissues
EXCEPTIONS:
Soft malignant lesions such as mucinous, medullary, papillary and some infiltrating
ductal carcinomas.
Hard benign lesions, Hyalinised fibro adenomas and fat necrosis.

9. RESULTS Esie touch- strain elastography ARFI -VTI
All malignant lesions in our study showed dark elastogram on VTI.
Out of 14 benign lesions 11,showed intermediate and 3 showed dark elastogram which may be due to hard lesions or due to excessive compression resulting in false positives.
All malignant lesions showed score 5 and benign lesions showed scores 2,3,and 4 on esie touch depending on the degree of hardness

10. SHEAR WAVE VELOCITIES MALIGNANT LESIONS BENIGN LESIONS
Average shear wave velocities are higher with in the lesion compared to the border, which are in turn higher compared to the glandular tissue and fat respectively for both benign and malignant lesions.
These values are higher for malignant lesions compared to the benign lesions.

11. MALIGNANT LESIONS
Out of the 12 malignant lesions 2 of the BIRADS-IV category lesions were correctly upgraded to BIRADS V after using elastography

12. BENIGN LESIONS
Out of the 14 malignant lesions 4 of the BIRADS-IV category lesions were correctly downgraded to BIRADS -III after using elastography. Two of the lesions showed false positive results as one was a hyalinized fibroadenoma and another was sclerosing intraductal papilloma.

13. CONCLUSION
Addition of Elasticity imaging was useful because it corroborated better with histopathology and increased our confidence levels in characterization of breast lesions and reduced the need for biopsies.
ACR BIRADS ATLAS Vth EDITION has added elasticity assessment as a parameter in the associated features unlike the previous editions.

14. RFERENCES
Beatriz Navarro, MD, Belen Ubeda , MD, Merce Vallespi, MD, Casandra Wolf, MD, Lilian Casas, MD,Jean L.Browne, MD
WEI MENG,GUANGCHEN ZHANG,CHANGJUN WU,GUOZHU WU,YAN SONG,ZHAOLING LU
Ultrasound department,The first affiliated Hospital of Harbin Medical University ,Harbin,China;and Technology
Department ,Siemens of Chindex International Inc.,China
Jianqiao zhou, MD,Weiwei zhan, MD,Cai Chang ,MD, Jinwen zhang,MD, Zhifang,MD,Yijie Dong, MD,Chun Zhou,MD,Yanyan Song,phD