The Utility of the Bull's-Eye Artifact on Breast Elasticity Imaging in Reducing Breast Lesion Biopsy Rate

Purpose: The objectives of the study were to evaluate the accuracy of the bull's-eye artifact of elasticity imaging (EI) in determining the benignity of cystic breast lesions and to determine the utility of such artifact in reducing the biopsy rate of the benign lesions. Methods: This study was performed under local institutional review board supervision and was in compliance with the Health Insurance Portability and Accountability Act of 1996. A retrospective review of 383 breast lesions from 309 consecutive patients undergoing diagnostic breast ultrasonography with EI (Siemens Antares or Siemens S2000; Siemens Healthcare, Mountain View, Calif) was conducted. The B-mode characteristics of those lesions determined whether biopsy was conducted. Pathological reports of the biopsied lesions were reviewed. Lesions demonstrating the bull's-eye artifact on EI were determined. The accuracy of the artifact in determining the benignity of cystic breast lesions was determined. Results: Of the 383 lesions, 243 lesions were recommended for biopsy based on the B-mode characteristics (biopsy rate, 63.4%). Of those 243 lesions, 62 lesions demonstrated the bull's-eye artifact on El, and all were confirmed benign cysts on pathological reports. Of the 181 lesions without the artifact, 116 were benign noncystic lesions, and 65 were malignant noncystic lesions. Hence, within the biopsied lesions, the bull's-eye artifact had perfect sensitivity, specificity, and positive predictive value in determining pathologically proven benign cysts. If the artifact can be used as a criterion to exclude lesions from biopsy, then the biopsy rate will be 181 (47.3%) of 383, significantly lower than the 63.4% biopsy rate without using this criteria (P< 0.001. Conclusions: The bull's-eye artifact seen on EI on Siemens ultrasonography equipment is a promising tool in the evaluation and characterization of benign breast cysts and has the potential to significantly reduce the amount of unnecessary breast biopsy.