Breast Diseases: A Year Book®

Quarterly 349Vol 18 No 4 2008 349

DIAGNOSTIC IMAGING

logically confirmed focal breast lesions(59 benign, 49 malignant; median age,53.9 years; range, 16-84 years). Tumorand healthy tissue were differentiated bymeasurement of elasticity based on thecorrelation between tissue properties andelasticity modulus. Evaluation was per-formed using the three-dimensional (3D)finite element method, in which the infor-mation is color-coded and superimposedon the B-mode ultrasound image. A sec-ond observer evaluated the elastographyimages, in order to improve the objectivi-ty of the method. The results of B-modescan and elastography were comparedwith those of histology and previoussonographic findings. Sensitivities andspecificities were calculated, taking his-tology as the gold standard.

Results.—B-mode ultrasound had asensitivity of 91.8% and a specificity of

78%, compared with sensitivities of77.6% and 79.6% and specificities of91.5% and 84.7%, respectively, for thetwo observers evaluating elastography.Agreement between B-mode ultrasoundand elastography was good, yielding aweighted kappa of 0.67.

Conclusions.—Our initial clinical re-sults suggest that real-time elastographyimproves the specificity of breast lesiondiagnosis and is a promising new ap-proach for the diagnosis of breast cancer.Elastography provides additional infor-mation for differentiating malignant BI-RADS (breast imaging reporting and datasystem) category IV lesions.

Please see the expert perspectiveby Merritt.

4–6Real-time elastography–anadvanced method of ultrasound:first results in 108 patients withbreast lesions Thomas A, Fischer T, Frey H, et al(Charité–Universitätsmedizin Berlin; St-Gertrauden-Hosp, Berlin; Physikalisch-Technische Bundesanstalt, Berlin; et al)

Ultrasound Obstet Gynecol 28:335-340, 2006

Objectives.—To evaluate whetherreal-time elastography, a new, non-invasive method for the diagnosis ofbreast cancer, improves the differentiationand characterization of benign and malig-nant breast lesions.

Methods.—Real-time elastographywas carried out in 108 potential breast tu-mor patients with cytologically or histo-

4–7MRI for diagnosis of pureductal carcinoma in situ: aprospective observational study Kuhl CK, Schrading S, Bieling HB, et al(Univ of Bonn, Germany)

Lancet 370:485-492, 2007

Background.—Diagnosing breastcancer in its intraductal stage might behelpful to prevent the development of in-vasive cancer. Our aim was to investigatethe sensitivity with which ductal carcino-ma in situ (DCIS) is diagnosed by mam-mography and by breast MRI.

Methods.—During a 5-year period,7319 women who were referred to an

academic national breast centre receivedMRI in addition to mammography for diagnostic assessment and screening.Mammograms and breast MRI studieswere assessed independently by differ-ent radiologists. We investigated the sensitivity of each method of detectionand compared the biological profiles ofmammography-diagnosed DCIS versusDCIS detected by MRI alone. We alsocompared the risk profiles of womenwith mammography-detected DCIS withthose of MRI-detected DCIS.

Findings.—193 women received afinal surgical pathology diagnosis of pureDCIS. Of those, 167 had undergone bothimaging tests preoperatively. 93 (56%) ofthese cases were diagnosed by mam-

mography and 153 (92%) by MRI (p <0.0001). Of the 89 high-grade DCIS, 43(48%) were missed by mammography,but diagnosed by MRI alone; all 43 cases missed by mammography were de-tected by MRI. By contrast, MRI detect-ed 87 (98%) of these lesions; the two cases missed by MRI were detected bymammography. Age, menopausal status,personal or family history of breast cancer or of benign breast disease, andbreast density of women with MRI-onlydiagnosed DCIS did not differ signifi-cantly from those of women with mammography-diagnosed DCIS.

Interpretation.—MRI could helpimprove the ability to diagnose DCIS, es-pecially DCIS with high nuclear grade.