Diagnostic Performance and Accuracy of the 3 Interpreting Methods of Breast Strain Elastography: A Systematic Review and Meta-analysis

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Abstract

There are 3 methods of interpreting breast strain elastography: the elastographic–to–B-mode length ratio (E/B), a 5-point color scale (5P), and the strain ratio (SR). This meta-analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy-proven or long-term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full-text articles were examined, and 46 were included in the meta-analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77%; specificity, 87%; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87%; specificity, 81%; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96%; specificity, 88%; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50% to a 2% probability of malignancy. © 2018 by the American Institute of Ultrasound in Medicine
Original languageEnglish
Pages (from-to)1397-1404
Number of pages8
JournalJournal of Ultrasound in Medicine
Volume38
Issue number6
DOIs
Publication statusPublished - 2019

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Elasticity Imaging Techniques
Meta-Analysis
Breast
Publications
Color
Medicine
Biopsy

Keywords

  • breast
  • breast cancer
  • breast tumors
  • elastography
  • sonoelastography
  • Diagnosis
  • Stability criteria
  • Breast Cancer
  • Breast tumor
  • Elastography
  • Sonoelastography
  • Medical imaging

Cite this

@article{01860bca6cc1479faedcf0c60862cfb1,
title = "Diagnostic Performance and Accuracy of the 3 Interpreting Methods of Breast Strain Elastography: A Systematic Review and Meta-analysis",
abstract = "There are 3 methods of interpreting breast strain elastography: the elastographic–to–B-mode length ratio (E/B), a 5-point color scale (5P), and the strain ratio (SR). This meta-analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy-proven or long-term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full-text articles were examined, and 46 were included in the meta-analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77{\%}; specificity, 87{\%}; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87{\%}; specificity, 81{\%}; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96{\%}; specificity, 88{\%}; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50{\%} to a 2{\%} probability of malignancy. {\circledC} 2018 by the American Institute of Ultrasound in Medicine",
keywords = "breast, breast cancer, breast tumors, elastography, sonoelastography, Diagnosis, Stability criteria, Breast Cancer, Breast tumor, Elastography, Sonoelastography, Medical imaging",
author = "R.G. Barr and {De Silvestri}, A. and V. Scotti and F. Manzoni and C. Rebuffi and C. Capittini and C. Tinelli",
note = "Export Date: 10 October 2019 CODEN: JUMED Correspondence Address: Barr, R.G.; Department of Radiology, Northeastern Ohio Medical UniversityUnited States; email: rgbarr@zoominternet.net References: Krouskop, T.A., Wheeler, T.M., Kallel, F., Garra, B.S., Hall, T., Elastic moduli of breast and prostate tissues under compression (1998) Ultrason Imaging, 20, pp. 260-274; Barr, R.G., Sonographic breast elastography: a primer (2012) J Ultrasound Med, 31, pp. 773-783; Barr, R.G., Nakashima, K., Amy, D., WFUMB guidelines and recommendations for clinical use of ultrasound elastography, part 2: breast (2015) Ultrasound Med Biol, 41, pp. 1148-1160; Barr, R.G., Destounis, S., Lackey, L.B., II, Svensson, W.E., Balleyguier, C., Smith, C., Evaluation of breast lesions using sonographic elasticity imaging: a multicenter trial (2012) J Ultrasound Med, 31, pp. 281-287; Barr, R.G., Real-time ultrasound elasticity of the breast: initial clinical results (2010) Ultrasound Q, 26, pp. 61-66; Destounis, S., Arieno, A., Morgan, R., Clinical experience with elasticity imaging in a community-based breast center (2013) J Ultrasound Med, 32, pp. 297-302; Ueno, E., Tohno, E., Soeda, S., Dynamic tests in real-time breast echography (1988) Ultrasound Med Biol, 14, pp. 53-57; Ueno, E., Itoh, A., Diagnosis of breast cancer by elasticity imaging (2004) Eizo Joho Med, 36, pp. 2-6; Ueno, E., Umemoto, T., Bando, H., Tohno, E., Waki, K., Matsumura, T., New quantitative method in breast elastography fat lesion ratio (FLR). Paper presented at Radiological Society of North America 93rd Scientific Assembly and Annual Meeting; November 25–30, 2007; Chicago, IL; Henderson, M., Tierney, L.M., Smetana, G.W., (2012) The Patient History, , 2nd, ed., New York, NY, McGraw-Hill; Moses, L.E., Shapiro, D., Littenberg, B., Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations (1993) Stat Med, 12, pp. 1293-1316; Barr, R.G., Zhang, Z., Shear wave elastography of the breast: value of a quality measure and comparison to strain elastography (2015) Radiology, 275, pp. 45-53; Barr, R.G., Zhang, Z., Effects of precompression on elasticity imaging of the breast: development of a clinically useful semiquantitative method of precompression assessment (2012) J Ultrasound Med, 31, pp. 895-902; Chen, L., He, J., Liu, G., Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis (2014) Jpn J Radiol, 32, pp. 592-599; Liu, B., Zheng, Y., Huang, G., Breast lesions: quantitative diagnosis using ultrasound shear wave elastography—a systematic review and meta-analysis (2016) Ultrasound Med Biol, 42, pp. 835-847; Barr, R.G., (2014) Breast Elastography, , New York, NY, Thieme Publishers; Grajo, J.R., Barr, R.G., Strain elastography in the prediction of breast cancer tumor grade (2014) J Ultrasound Med, 33, pp. 129-134; Yang, W.T., Parikh, J.R., Stavros, A.T., Otto, P., Maislin, G., Exploring the negative likelihood ratio and how it can be used to minimize false-positives in breast imaging (2018) AJR Am J Roentgenol, 210, pp. 301-306",
year = "2019",
doi = "10.1002/jum.14849",
language = "English",
volume = "38",
pages = "1397--1404",
journal = "Journal of Ultrasound in Medicine",
issn = "0278-4297",
publisher = "American Institute of Ultrasound in Medicine",
number = "6",

}

TY - JOUR

T1 - Diagnostic Performance and Accuracy of the 3 Interpreting Methods of Breast Strain Elastography: A Systematic Review and Meta-analysis

AU - Barr, R.G.

AU - De Silvestri, A.

AU - Scotti, V.

AU - Manzoni, F.

AU - Rebuffi, C.

AU - Capittini, C.

AU - Tinelli, C.

N1 - Export Date: 10 October 2019 CODEN: JUMED Correspondence Address: Barr, R.G.; Department of Radiology, Northeastern Ohio Medical UniversityUnited States; email: rgbarr@zoominternet.net References: Krouskop, T.A., Wheeler, T.M., Kallel, F., Garra, B.S., Hall, T., Elastic moduli of breast and prostate tissues under compression (1998) Ultrason Imaging, 20, pp. 260-274; Barr, R.G., Sonographic breast elastography: a primer (2012) J Ultrasound Med, 31, pp. 773-783; Barr, R.G., Nakashima, K., Amy, D., WFUMB guidelines and recommendations for clinical use of ultrasound elastography, part 2: breast (2015) Ultrasound Med Biol, 41, pp. 1148-1160; Barr, R.G., Destounis, S., Lackey, L.B., II, Svensson, W.E., Balleyguier, C., Smith, C., Evaluation of breast lesions using sonographic elasticity imaging: a multicenter trial (2012) J Ultrasound Med, 31, pp. 281-287; Barr, R.G., Real-time ultrasound elasticity of the breast: initial clinical results (2010) Ultrasound Q, 26, pp. 61-66; Destounis, S., Arieno, A., Morgan, R., Clinical experience with elasticity imaging in a community-based breast center (2013) J Ultrasound Med, 32, pp. 297-302; Ueno, E., Tohno, E., Soeda, S., Dynamic tests in real-time breast echography (1988) Ultrasound Med Biol, 14, pp. 53-57; Ueno, E., Itoh, A., Diagnosis of breast cancer by elasticity imaging (2004) Eizo Joho Med, 36, pp. 2-6; Ueno, E., Umemoto, T., Bando, H., Tohno, E., Waki, K., Matsumura, T., New quantitative method in breast elastography fat lesion ratio (FLR). Paper presented at Radiological Society of North America 93rd Scientific Assembly and Annual Meeting; November 25–30, 2007; Chicago, IL; Henderson, M., Tierney, L.M., Smetana, G.W., (2012) The Patient History, , 2nd, ed., New York, NY, McGraw-Hill; Moses, L.E., Shapiro, D., Littenberg, B., Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations (1993) Stat Med, 12, pp. 1293-1316; Barr, R.G., Zhang, Z., Shear wave elastography of the breast: value of a quality measure and comparison to strain elastography (2015) Radiology, 275, pp. 45-53; Barr, R.G., Zhang, Z., Effects of precompression on elasticity imaging of the breast: development of a clinically useful semiquantitative method of precompression assessment (2012) J Ultrasound Med, 31, pp. 895-902; Chen, L., He, J., Liu, G., Diagnostic performances of shear-wave elastography for identification of malignant breast lesions: a meta-analysis (2014) Jpn J Radiol, 32, pp. 592-599; Liu, B., Zheng, Y., Huang, G., Breast lesions: quantitative diagnosis using ultrasound shear wave elastography—a systematic review and meta-analysis (2016) Ultrasound Med Biol, 42, pp. 835-847; Barr, R.G., (2014) Breast Elastography, , New York, NY, Thieme Publishers; Grajo, J.R., Barr, R.G., Strain elastography in the prediction of breast cancer tumor grade (2014) J Ultrasound Med, 33, pp. 129-134; Yang, W.T., Parikh, J.R., Stavros, A.T., Otto, P., Maislin, G., Exploring the negative likelihood ratio and how it can be used to minimize false-positives in breast imaging (2018) AJR Am J Roentgenol, 210, pp. 301-306

PY - 2019

Y1 - 2019

N2 - There are 3 methods of interpreting breast strain elastography: the elastographic–to–B-mode length ratio (E/B), a 5-point color scale (5P), and the strain ratio (SR). This meta-analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy-proven or long-term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full-text articles were examined, and 46 were included in the meta-analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77%; specificity, 87%; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87%; specificity, 81%; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96%; specificity, 88%; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50% to a 2% probability of malignancy. © 2018 by the American Institute of Ultrasound in Medicine

AB - There are 3 methods of interpreting breast strain elastography: the elastographic–to–B-mode length ratio (E/B), a 5-point color scale (5P), and the strain ratio (SR). This meta-analysis assessed which method is superior to the others. A systematic search of the medical literature was performed in July 2017. Studies were eligible for inclusion if they fulfilled the following criteria: (1) had biopsy-proven or long-term stability as the reference standard; (2) used either the E/B, 5P, or SR to interpret results; and (3) had at least 50 cases. A total of 220 records were retrieved; 60 full-text articles were examined, and 46 were included in the meta-analysis. Publication years ranged from 2007 and 2017. The quality of studies was generally high. The mean age of women was 48 years; 12,398 lesions (4242 malignant) were analyzed. For the 5P method, the sensitivity was 77%; specificity, 87%; positive likelihood ratio (LR), 5.3; and negative LR, 0.24. For the SR method, sensitivity was 87%; specificity, 81%; positive LR, 4.8; and negative LR, 0.16. For the E/B method, sensitivity was 96%; specificity, 88%; positive LR, 7.1; and negative LR, 0.03. Of the 3 methods, the E/B had the highest sensitivity, and the E/B and 5P had the highest specificity. With a negative LR of 0.03, the E/B method can downgrade lesions with a pretest probability of 50% to a 2% probability of malignancy. © 2018 by the American Institute of Ultrasound in Medicine

KW - breast

KW - breast cancer

KW - breast tumors

KW - elastography

KW - sonoelastography

KW - Diagnosis

KW - Stability criteria

KW - Breast Cancer

KW - Breast tumor

KW - Elastography

KW - Sonoelastography

KW - Medical imaging

U2 - 10.1002/jum.14849

DO - 10.1002/jum.14849

M3 - Article

VL - 38

SP - 1397

EP - 1404

JO - Journal of Ultrasound in Medicine

JF - Journal of Ultrasound in Medicine

SN - 0278-4297

IS - 6

ER -