Shear wave elastography contribution in ultrasound diagnosis management of breast lesions.

PURPOSE: To determine the diagnosis performance of shear wave elastography in the differentiation of benign and malignant breast lesions and the factors influencing the elasticity values. To suggest an appropriate management of breast lesions using the ultrasound-elastography combination. PATIENTS AND METHODS: Monocentric retrospective study of 167 breast lesions classified by conventional ultrasound as BI-RADS category 3 or higher that underwent an elastography study and histological analysis. RESULTS: The analysis of qualitative parameters, according to the classification established in this study, allows us to obtain a sensitivity of 91.1% and a specificity of 92.3%. These values are very close to or better than the quantitative parameters Emax and Emean. Different Emax thresholds values were established based on the long axis of the lesion and its palpable character, which appeared to be significant factors influencing elasticity. The management of breast lesions by combining ultrasound and elastography, as proposed here, allows us to keep the sensitivity of an ultrasound (96%), while doubling its specificity (86.2% versus 43.1%). CONCLUSION: With the complementary nature of their performance, the combination of conventional ultrasound and shear wave elastography can improve the management of breast lesions. The qualitative classification proposed appears to be relevant assistance in lesion characterization.

[Peritoneal carcinosis in ovarian cancer: conventional imaging (CT-scan and MRI)]. / Imagerie conventionnelle << péritonéale >> des cancers de l'ovaire (scanner, IRM).

Ovarian cancer is usually diagnosed at an advanced stage with peritoneal extension which often occurs early on. Imaging plays an important role in the pretherapeutic assessment of peritoneal extension. Carcinomatosis involving the hepatic hilum, the cavo-supra-hepatic confluence, the mesentery, and/or the intestinal wall precludes optimal surgery and may be an indication for neoadjuvant chemotherapy. Abdominal and pelvic MDCT scan is the best imaging technique for the preoperative staging of peritoneal carcinomatosis. MRI can be useful in some cases. Conventional imaging however sometimes underestimates peritoneal carcinomatosis and therefore cannot always be a substitute for surgical staging.