Accuracy of tumor size measurement on shear wave elastography (SWE): Correlation with histopathologic factors of invasive breast cancer.

The aim of this study is to investigate the accuracy of tumor size assessment by shear wave elastography (SWE) in invasive breast cancer and also evaluated histopathologic factors influencing the accuracy.A total of 102 lesions of 102 women with breast cancers of which the size was 3 cm or smaller were included and retrospectively analyzed. Tumor size on B-mode ultrasound (US) and SWE were recorded and compared with the pathologic tumor size. If tumor size measurements compared to pathological size were within ±3 mm, they were considered as accurate. The relationship between the accuracy and histopathologic characteristics were evaluated.The mean pathologic tumor size was 16.60 ±â€Š6.12 mm. Tumor sizes on SWE were significantly different from pathologic sizes (18.00 ±â€Š6.71 mm, P < 0.001). The accuracy of SWE (69.6%) was lower than that by B-mode US (74.5%). There was more size overestimation than underestimation (23.5% vs 6.9%) using SWE. Conversely, there was more size underestimation than overestimation (18.6% vs 6.9%) using B-mode US. The accuracy of SWE was associated with ER positivity (P = .004), PR positivity (P = .02), molecular subtype (P = .02), and histologic grade (P = .03). In the multivariate analysis, ER positivity (P = .002) and molecular subtype (P = .027) significantly influenced the accuracy of tumor size measurement by SWE.In conclusion, the accuracy of the tumor size measured with SWE was lower than that measured with B-mode US and SWE tends to overestimate the size. ER positivity and molecular subtype are significantly associated with the accuracy of SWE in tumor size assessment.

The additional utility of ultrafast MRI on conventional DCE-MRI in evaluating preoperative MRI of breast cancer patients.

PURPOSE: To investigate whether the additional use of ultrafast MRI can improve the diagnostic performance of conventional dynamic contrast-enhanced MRI (DCE-MRI) in evaluating MRI-detected lesions in breast cancer patients. METHODS: This retrospective study enrolled 101 consecutive breast cancer patients with 202 breast lesions (62 benign and 140 malignant) who underwent preoperative DCE-MRI with ultrafast imaging (9 image sets with 6.5-second temporal resolution). Two reviewers assessed the BI-RADS categories of breast lesions using conventional DCE-MRI and assessed the following parameters using the ultrafast MRI: initial enhancement phase, maximum relative enhancement, slope, and maximum slope (slopemax) on the kinetic curve. Interobserver agreement was analyzed between the two reviewers. The ultrafast MRI parameters were compared between benign and malignant tumors, and cut-off values were determined. For 97 additional MRI-detected lesions, the BI-RADS category was re-assessed using cut-off values, and the diagnostic performance was compared between the conventional DCE-MRI and the combined conventional and ultrafast DCE-MRI. RESULTS: All ultrafast MRI parameters differed significantly between malignant and benign tumors (p < 0.001). Initial enhancement phase by reviewer and slopemax were the top two parameters showing significant differences between benign and malignant tumors with high reliability. With the use of cut-off values for initial enhancement phase (≤phase 2) and slopemax (>9.8%/sec), the specificity of conventional DCE-MRI was significantly increased (29.4% vs 64.7%, p < 0.001) without significant loss of sensitivity (100% vs 88.2%, p = 0.157) in evaluating masses. CONCLUSIONS: The additional use of ultrafast MRI can improve the specificity of conventional DCE-MRI when evaluating MRI-detected masses in breast cancer patients.

Can Ultrasonographic Vascular and Elastographic Features of Invasive Ductal Breast Carcinoma Predict Histologic Aggressiveness?

RATIONALE AND OBJECTIVES: To investigate if preoperative ultrasonographic vascular and shear-wave elastographic examinations can predict histologic aggressiveness. MATERIALS AND METHODS: Preoperative ultrasonographic vascular features and shear-wave elasticities were retrospectively evaluated for 147 invasive ductal carcinomas. Vascular feature was assessed using four-tier vascularity score. Mean and maximum elasticities (Emean and Emax), and the lesion-to-fat ratio (Eratio) were documented. Histologic parameters were reviewed for tumor size, multiplicity, axillary lymph node status, lymphovascular invasion, histologic grade, estrogen receptor, progesterone receptor, human epidermal growth factor receptor2 (HER2), Ki-67, p53, and histologic subtype. Vascularity score and elasticities were correlated with histologic parameters and histologic parameters were compared between the group with low vascularity score and elasticities and the group with high vascularity score and elasticities using ANOVA, chi-squared test, and regression analysis. RESULTS: Vascularity score was independently associated with tumor size (p = 0.010) and HER2 (p = 0.007). Emean and Emax were associated with tumor size, histologic grade, and lymphovascular invasion, and Eratio was associated with tumor size, histologic grade, estrogen receptor, progesterone receptor, Ki-67, and histologic subtype (p < 0.05). Emean and Emax were independently associated with tumor size (p < 0.001). The group with high vascularity score and Eratio showed large tumor size (p < 0.001) and HER2 positivity (p = 0.039) in comparison to the group with low vascularity score and Eratio. CONCLUSION: Ultrasonographic vascular features were associated with tumor size and HER2. SWE elasticities were associated with tumor size, histologic grade, hormonal receptor, and histologic subtype. Therefore, preoperative vascular and elastographic examinations could predict histologic aggressiveness of invasive ductal breast carcinoma.

Complications and Radiologic Features of Breast Augmentation via Injection of Aquafilling Gel.

Many attempts have been made to augment breasts using injectable materials; however, various complications are associated with these materials. Aquafilling gel (Aquafilling, Podebrady, Czech Republic) is a new soft tissue filler that has been used as an implant material for the face and lip and recently for breast augmentation. This article describes 3 cases of augmentation mammoplasty using Aquafilling gel, focusing on their complications and radiologic features.