Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions

Purpose. This study was performed to evaluate the diagnostic accuracy of sonoelastography in differentiating and characterising nodular breast lesions. Materials and methods. A total of 120 nodular lesions diagnosed on mammography and/or ultrasonography in 110 women (mean age 51.27 years) were evaluated with sonoelastography and classified according to elasticity score (S1-S5). Needle biopsy was performed in 104/120 cases, whereas 16/120 were sent for follow-up. Sensitivity and specificity of sonoelastography were determined by taking biopsy findings as the gold standard. Results. Biopsy yielded the following results: 66 benign, three equivocal and 35 malignant lesions. Sensitivity and specificity of sonoelastography were, respectively, 88.5% and 92.7%. All nodules with an elasticity score of 5 were malignant, and those with a score <= 3 were benign, with the exception of four cases of invasive carcinoma with atypical elasticity (two lobular and two ductal with liquefaction necrosis). Twenty-two lesions were scored 4: 17 were malignant, two equivocal (columnar cell hyperplasia and complex sclerosing lesion) and three benign (sclerotic fibroadenomas). Conclusions. The use of sonoelastography to complement mammography and ultrasonography could help in the differential diagnosis of nodular breast lesions, especially in Breast Imaging Reporting Data System (BI-RADS) 3 lesions with marked elasticity (S <= 3). In these cases, the high concordance between elastography and cytology or histology in diagnosing benign lesions could reduce the number of needle biopsies and guide women at low radiological risk towards follow-up.