Shear wave versus strain elastography of breast lesions-The value of incorporating boundary tissue assessment.

PURPOSE: This prospective study compares the diagnostic performance of strain elastography (SE) based on the elastogram to B-mode (E/B) size ratio to shear-wave elastography (SWE) incorporating assessment of boundary tissue stiffness. METHODS: In this prospective study, 81 women consented to undergo ultrasound (US) elastographic assessment prior to biopsy of their mass(es). A total of 101 masses were evaluated with SE and SWE using a single machine (Siemens Acuson S2000). The histopathologic diagnosis was used as the reference standard. The sensitivity, specificity and area under curve (AUC) were obtained for SE and SWE. RESULTS: The sensitivity and specificity of SE using the E/B ratio was 94.7% (95% CI: 87.6 100) and 81.0% (95% CI: 71.3 90.1) respectively. For SWE the sensitivity and specificity was 73.7% (95% CI: 59.7 87.7) and 82.5% (95% CI: 73.2 91.9) respectively. The AUC for SE was higher (0.878) compared to SWE (0.697). CONCLUSION: SE elastography using the E/B ratio yields diagnostic performance which is superior to SWE incorporating assessment of peripheral stiffness.

Women's Experience With Screening Mammography During the COVID-19 Pandemic: A Multi-Institutional Prospective Survey Study.

OBJECTIVE: Evaluate women's anxiety and experience undergoing screening mammography during the COVID-19 pandemic. METHODS: An IRB-approved anonymous survey was administered to women receiving screening mammography across six sites in the U.S. and Singapore from October 7, 2020, to March 11, 2021. Using a 1-5 Likert scale, women rated their pre- and post-visit anxiety regarding having their mammogram during the COVID-19 pandemic, importance of observed COVID-19 precautions, and personal risk factors for breast cancer and severe COVID-19 illness. Post-visit change in anxiety was evaluated. Multivariable logistic regression was used to test associations of pre-visit anxiety with breast cancer and COVID-19 risk factors. RESULTS: In total, 1086 women completed the survey. Of these, 59% (630/1061) had >1 breast cancer risk factor; 27% (282/1060) had >1 COVID-19 risk factors. Forty-two percent (445/1065) experienced pre-visit anxiety. Pre-visit anxiety was independently associated with risk factors for severe COVID-19 (OR for >2 vs 0 risk factors: 2.04, 95% confidence interval [CI]: 1.11-3.76) and breast cancer (OR for >2 vs 0 risk factors: 1.71, 95% CI: 1.17-2.50), after adjusting for age and site. Twenty-six percent (272/1065) of women reported post-visit anxiety, an absolute 16% decrease from pre-visit anxiety (95% CI: 14%-19%, P < 0.001). Provider masking (941/1075, 88%) and physical distancing (861/1085, 79%) were rated as the most important precautions. CONCLUSION: Pre-visit anxiety was associated with COVID-19 or breast cancer risk factors and declined significantly after screening mammography. Provider masking and physical distancing were rated the most important precautions implemented by imaging clinics.

Comparative Study of Pattern-Based Versus Size Ratio Ultrasound Strain Elastographic Techniques on Breast Masses.

OBJECTIVES: The aim of this study was to compare the diagnostic performance of strain elastographic techniques involving pattern-based elastography versus size ratio elastography on breast masses. METHODS: Female patients presenting to the radiology department for ultrasound (US)-guided biopsies, fine-needle aspirations, or localizations of breast masses were invited to undergo US elastographic assessments of the lesions before the breast procedures. The masses were evaluated for color score and color map size ratio elastographic assessments with one US machine and size ratio and grayscale strain pattern elastographic assessments with another machine. With the histopathologic diagnosis as the reference standard, the sensitivity, specificity, and area under the receiver operating characteristic curve were compared among the 4 groups. RESULTS: A total of 154 breast masses from 139 women were assessed. The sensitivity and specificity were 0.615 (95% confidence interval, 0.470-0.747) and 0.824 (0.736-0.892), respectively for the color score, 0.962 (0.868-0.995) and 0.765 (0.670-0.843) for the size ratio, 0.904 (0.790-0.968) and 0.745 (0.649-0.826) for the color map size ratio, and 0.635 (0.490-0.764) and 0.422 (0.324-0.523) for the grayscale strain pattern. The areas under the receiver operating characteristic curve were 0.729 for the color score, 0.874 for the size ratio (P = .001 with the color score as a reference), 0.836 for the color map size ratio (P = .002), and 0.556 for the grayscale strain pattern (P < .001). CONCLUSIONS: Size ratio elastography had higher sensitivity and better diagnostic accuracy compared to color score elastography. This superiority was demonstrated on two different US systems, and size ratio elastography should thus be considered over color score elastography in the adjunctive US assessment of breast lesions.

Clinics in diagnostic imaging (180). Ductal carcinoma in situ (DCIS).

A 26-year-old woman presented with a slow-growing right breast lump. Excision biopsy of the lump showed invasive ductal carcinoma with adjacent ductal carcinoma in situ (DCIS). Preoperative imaging was performed to assess the extent of disease. Magnetic resonance (MR) imaging of the breasts showed an area of clustered ring enhancement deep to the biopsy site, which was representative of residual DCIS. DCIS is a common noninvasive malignancy that manifests as a primary breast tumour or in association with other lesions. The radiological features of DCIS are discussed herein, with special attention to the clustered ring enhancement pattern on MR imaging.