M. Martin1, N. Zaremba1, D. Anderson2, A. Davis1, S. Schafer2, H. Bumpers1 1Michigan State University,Department Of Surgery,Lansing, MI, USA 2Michigan State University,Department Of Radiology,East Lansing, MICHIGAN, USA
Introduction: Sonoelastography (SE) is an evolving breast imaging tool that has a theoretical and practical basis. SE combines compression and ultrasonography to estimate tissue elasticity. Breast cancer is generally firmer than adjacent benign tissue. A quantitative score (1-5) is assigned to an image created over the lesion. Benign lesions appear softer and more green (scores 1-3) and malignant lesions are usually less elastic and blue (scores 4-5). SE may vary due to histolopathology. Factors thought to contribute to disparities between White American (WA) and African Amercian (AA) women are late stage disease, characterized by large tumors and advanced disease. Racial differences in SE has not been studied, and it is unknown if tumor elastic properties differ. The purpose was to evaluate SE in definining elastic properties of breast lesions in WA and AA women.
Methods: From January 2012 through January 2013, patients’ charts were reviewed for demographics, pathology, and breast imaging. SE scores were assigned according to the Tsukuba Elasticity Score (TES) system. Correlation was made between two races (WA and AA) and tumors malignancy or benignity. Descriptive statistics were performed. This study was approved by the Institutional Review Board of Michigan State University.
Results: SE was performed in 181 women with a mean age of 49.7±15.2 years (±SD). Of the 205 lesions identified, 183 were in WA women (62 malignant, 121 benign), and 22 in AA women (5 malignant, 17 benign).
The mean TES for malignant lesions in WA women was 3.1±1.1, and 2.4±1.7 for AA’s (p = 0.32). The mean TES for benign lesions in WA women was 1.9±1.4, and 2.4±1.4 for AA women (p = 0.06). No significant racial differences were noted in elasticity for malignant or benign tumors.
Among all malignant lesions in both WA and AA women, the mean TES was 3.1±1.1, the mean BI-RADS was 4.4±0.6. This indicates that suspicious lesions are less elastic. ER/PR/Her2-neu characteristics, including triple negative tumors (TNT), did not influence SE. All malignant lesions had a TES of 2 or higher, and 79.1% (53/67) were infiltrating ductal carcinoma. In lesions coded BI-RADS 3 and 4, the mean TES in WA women was 2.5±1.3, and 3.0±0.7 in AA women (P = 0.12). A suggestion that AA women with suspicious BIRADS scores may have firmer tumors.
Benign lesions had a mean TES was 1.9±1.4, which was significantly less than the mean the TES of malignant lesions (3.1±1,1, p<0.001). SE will differentiate malignancy and benignity.
Conclusion: SE can be a useful diagnostic aid in the detection and differentiation of malignant and benign breast tissues. There was no demonstration of elasticity difference between breast tumors in WA and AA women. This study is the first to characterize the elastic properties of malignant and benign breast tumors between races.