Video sequence compared to conventional freeze image documentation: a way to improve the sonographic assessment of breast lesions?

PURPOSE: To compare video sequence and conventional freeze image documentation of breast ultrasound findings with respect to lesion assessment and the diagnostic power of established ultrasound characteristics. MATERIALS AND METHODS: Digitally stored freeze images and corresponding video sequences of 50 breast lesions were randomly arranged and interpreted by eight investigators with breast ultrasound training and experience. Established ultrasound criteria were documented on a standardized classification form for every lesion. The investigators were blinded to the clinical and radiological findings, patient characteristics including age, and lesion histology. Statistical analysis compared both groups and correlated the results with the lesion histology. A receiver operating characteristics (ROC) analysis was performed to evaluate the diagnostic performance of ultrasound criteria in lesions documented by video sequences compared to freeze images. RESULTS: Breast lesions were assessed almost identically in video sequences and freeze images. Only the features echogenic halo, orientation, and margin varied among both groups. The dynamic features compressibility and mobility were highly statistically significant correlated with the lesion histology in the video sequence interpretation (p < 0.0001). ROC analysis revealed almost identical diagnostic accuracy in both groups (area under the curve 0.719 for video sequences and 0.762 for freeze images). CONCLUSION: Video sequences are an appropriate tool to document lesions in breast ultrasound. In contrast to our hypothesis, however, this tool did not improve the diagnostic power of established ultrasound characteristics compared to freeze image documentation.

Three-dimensional ultrasound for the assessment of breast lesions.

OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional (3D) ultrasound in comparison with conventional two-dimensional (2D) ultrasound in the characterization of breast lesions. METHODS: The digitally stored 2D ultrasound images and the corresponding 3D scans of 100 breast lesions (57 malignant, 43 benign) that had been morphologically classified as solid tumors, were independently analyzed by six investigators. Ten 2D and 13 3D ultrasound characteristics were determined. Lesion characterization was classified on a four-point scale and a logistic regression model was used to analyze the data. A receiver-operating characteristics curve (ROC) analysis was performed to determine the diagnostic performance of 2D and 3D ultrasound, respectively. RESULTS: Ultrasound criteria showed major differences between 2D and 3D ultrasound. Logistic regression revealed the retraction phenomenon in the coronal plane of the 3D ultrasound scan to be a significant and independent factor for lesion characterization. The characteristics determined on the conventional planes of 3D ultrasound differed from those determined on the 2D ultrasound images. The diagnostic accuracy of 2D and 3D ultrasound in the ROC analysis was almost identical (area under the curve 0.846 and 0.851, respectively). CONCLUSIONS: Ultrasound features on 3D ultrasound differ significantly from those on 2D ultrasound. However, the diagnostic accuracy of both methods is almost identical. 3D ultrasound as an adjunct to conventional 2D ultrasound should be evaluated in larger trials to determine its clinical value in breast imaging.