The Value of VTTQ Combined with B-mode US for Distinguishing Benign from Malignant Breast Masses by Comparing with SE: A Clinical Research

doi:10.37015/AUDT.2023.220041

Abstract

Abstract:

Objective The purpose of this study was to compare the diagnostic performance of virtual touch tissue quantification (VTTQ) combined with B-mode ultrasonograpgy (US), strain elastography (SE) combined with B-mode US and B-mode US alone in differentiating the properties of breast lesions.

Methods A retrospective database was queried for 283 healthy subjects and 100 consecutive patients with 130 breast lesions. All the cases were examined by B-mode US, VTTQ and SE. Histological diagnosis was used as the reference standard. The area under the receiver operating curve (AUC) values of each data set was compared.

Results Twenty-two lesions were determined as malignant and 108 as benign. The best cutoff point of VTTQ was 7.82 m/s. The AUC of B-mode US combined with VTTQ or SE was greater than that of B-mode US alone (0.913 or 0.918 vs. 0.797) (P = 0.007 and 0.012).

Conclusion Both VTTQ and SE could give help to B-mode US in distinguishing benign from malignant breast lesions about elastography values. There was no difference between them.

Key words: B-mode ultrasonography; Virtual touch tissue quantification; Strain elastography

Lujing Li, MD, Zuofeng Xu, MD. The Value of VTTQ Combined with B-mode US for Distinguishing Benign from Malignant Breast Masses by Comparing with SE: A Clinical Research. Advanced Ultrasound in Diagnosis and Therapy, 2023, 7(4): 394-400.

Figures/Tables 7

Figure 1

Table 1

Table 2

Table 3

Table 4

Table 5

Figure 2

References 18

[1]	Hoffmann R, Reich C, Skerl K. Evaluating different combination methods to analyse ultrasound and shear wave elastography images automatically through discriminative convolutional neural network in breast cancer imaging. Int J Comput Assist Radiol Surg 2022; 17:2231-2237. doi: 10.1007/s11548-022-02737-6
[2]	Masroor I, Ahmed MN, Pash S. To evaluate the role of sonography as an adjunct to mammography in women with dense breasts. J Pak Med Assoc 2009; 59:298-301. pmid: 19438134
[3]	Maskarinec G, Meng L, Ursin G. Ethnic differences in mammographic densities. Int J Epidemiol 2001; 30:959-965. doi: 10.1093/ije/30.5.959 pmid: 11689504
[4]	American College of Radiology. Breast imaging reporting and data system, Breast imaging atlas. fifth ed. Reston 2013
[5]	Margolin FR, Leung JW, Jacobs RP, Denny SR. Percutaneous imaging-guided core breast biopsy: 5 years’ experience in a community hospital. AJR Am J Roentgenol 2001; 177:559-564. doi: 10.2214/ajr.177.3.1770559
[6]	Wiratkapun C, Bunyapaiboonsri W, Wibulpolprasert B, Lertsithichai P. Biopsy rate and positive predictive value for breast cancer in BI-RADS category 4 breast lesions. J Med Assoc Thai 2010; 93:830-837. pmid: 20649064
[7]	Matsumoto K, Miyaaki H, Fukushima M, Sasaki R, Haraguchi M, Miuma S, Nakao K. The impact of single-nucleotide polymorphisms on liver stiffness and controlled attenuation parameter in patients treated with direct-acting antiviral drugs for hepatitis C infection. Biomed Rep 2022; 16:9. doi: 10.3892/br.2021.1492 pmid: 34987793
[8]	Sigrist RMS, El Kaffas A, Jeffrey RB, Rosenberg J, Willmann JK. Intra-individual comparison between 2-D shear wave elastography (GE System) and virtual touch tissue quantification (Siemens System) in grading liver fibrosis. Ultrasound Med Biol 2017; 43:2774-2782. doi: S0301-5629(17)31295-4 pmid: 28967501
[9]	Bai M, Du L, Gu J, Li F, Jia X. Virtual touch tissue quantification using acoustic radiation force impulse technology: Initial clinical experience with solid breast masses. J Ultrasound Med 2012; 31:289-294. doi: 10.7863/jum.2012.31.2.289 pmid: 22298873
[10]	Zhi H, Ou B, Xiao XY, Peng YL, Wang Y, Liu LS, et al. Ultrasound elastography of breast lesions in Chinese women: A multicenter study in China. Clin Breast Cancer 2013; 13:392-400. doi: 10.1016/j.clbc.2013.02.015 pmid: 23830799
[11]	Tanter M, Bercoff J, Athanasiou A, Deffieux T, Gennisson JL, Montaldo G, et al. Quantitative assessment of breast lesion viscoelasticity: Initial clinical results using supersonic shear imaging. Ultrasound Med Biol 2008; 34:1373-1386. doi: 10.1016/j.ultrasmedbio.2008.02.002 pmid: 18395961
[12]	Tozaki M, Isobe S, Fukuma E. Preliminary study of ultrasonographic tissue quantification of the breast using the acoustic radiation force impulse (ARFI) technology. Eur J Radiol 2011; 80:e182-e187.
[13]	Wojcinski S, Brandhorst K, Sadigh G, Hillemanns P, Degenhardt F. Acoustic radiation force impulse imaging with Virtual Touch™ tissue quantification: mean shear wave velocity of malignant and benign breast masses. Int J Womens Health 2013; 5:619-627 doi: 10.2147/IJWH.S50953 pmid: 24109199
[14]	Tamaki K, Tamaki N, Kamada Y, Uehara K, Miyashita M, Ishida T, et al. A non-invasive modality: the US Virtual Touch Tissue Quantification (VTTQ) for evaluation of breast cancer. Jpn J Clin Oncol 2013; 43:889-895.
[15]	Berg WA, Cosgrove DO, Doré CJ, Schäfer FK, Svensson WE, Hooley RJ, et al. Shear-wave elastography improves the specificity of breast US: The BE 1 multinational study of 939 masses. Radiology 2012;262: 435-449.
[16]	Youk JH, Son EJ, Gweon HM, Kim H, Park YJ, Kim JA. Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B-mode ultrasonography: qualitative and quantitative assessments. Ultrasound Med Biol 2014; 40:2336-2344. doi: 10.1016/j.ultrasmedbio.2014.05.020 pmid: 25130444
[17]	Hou XJ, Sun AX, Zhou XL, Ji Q, Wang HB, Wei H, et al. The application of Virtual Touch tissue quantification (VTQ) in diagnosis of thyroid lesions: A preliminary study. Eur J Radiol 2013; 82:797-801. doi: 10.1016/j.ejrad.2012.12.023
[18]	Chang JM, Moon WK, Cho N, Kim SJ. Breast mass evaluation: factors influencing the quality of US elastography. Radiology 2011; 259:59-64

Benign lesions (n =108)		Malignant lesions (n = 22)
Histopathologic diagnosis	n	Histopathologic diagnosis	n
Fibroadenoma	74	Invasive ductal carcinoma	16
Fibrocystic mastopathy	19	Ductal carcinoma in situ	1
Benign phyllodes tumor	5	Mucinous carcinoma	1
Intraductal papilloma	4	Invasive micropapillary carcinoma	1
Tubular adenoma of breast	4	Malignant phyllodes tumor	1
Hyperplasia	1	Lobular carcinoma in situ	1
Chronic inflammation	1	Neuroendocrine carcinoma	1

Benign lesions (n =108)		Malignant lesions (n = 22)
Histopathologic diagnosis	Median SWVs (m/s)	Histopathologic diagnosis	Median SWVs (m/s)
Fibroadenoma	3.07 ± 1.21	Invasive ductal carcinoma	8.57 ± 1.71
Fibrocystic mastopathy	3.35 ± 2.15	Ductal carcinoma in situ	9.00
Benign phyllodes tumor	2.30 ± 0.33	Mucinous carcinoma	9.00
Intraductal papilloma	4.31 ± 3.16	Invasive micropapillary carcinoma	9.00
Tubular adenoma of breast	2.98 ± 0.69	Malignant phyllodes tumor	0.60
Hyperplasia	2.81	Lobular carcinoma in situ	3.13
Chronic inflammation	1.89	Neuroendocrine carcinoma	9.00

Lesion type	Score 1	Score 2	Score 3	Score 4	Score 5	Total
Benign, n	58	41	3	6	0	108
Malignant, n	1	1	1	13	6	22
Total	59	42	4	19	6	130

Item	Sensitivity (%)	Specificity (%)	Accuracy (%)	PPV (%)	NPV (%)
B-mode US	95.5	63.9	69.2	35	98.6
B-mode US combined with VTTQ	86.4	96.3^*	94.6^*	82.6	97.2
B-mode US combined with SE	90.9	92.6^*	92.3^*	71.4	98.0