Clinical Value of Shear Wave Elastography Added to Targeted Ultrasound (Second-Look Ultrasound) in the Evaluation of Breast Lesions Suspicious of Malignancy Detected on Magnetic Resonance Imaging.

OBJECTIVES: To determine the value of shear wave elastography (SWE) added to targeted ultrasound (US) after breast magnetic resonance imaging (MRI). METHODS: From July 2015 to October 2017, 40 patients who underwent targeted US evaluations of suspicious MRI-detected American College of Radiology Breast Imaging Reporting and Data System category 4 lesions (mass or nonmass enhancement) were enrolled in this prospective study. B-mode US and SWE examinations were performed to detect US correlates to MRI-detected lesions; their Breast Imaging Reporting and Data System categories were recorded; lesions that were dark blue on a 6-point color scale or had maximum elasticity of 30 kPa or less were categorized as soft. Biopsy was performed with US or MRI guidance, with the pathologic findings correlated with MRI, US, and SWE findings. The value of SWE for lesion detection and identification of benign lesions was determined. RESULTS: The mean age of the 40 patients was 51.1 years. There were 48 MRI-detected lesions (20 cancers, 3 high-risk lesions, and 25 benign lesions). Ultrasound correlates (8 category 3 and 25 category 4) were shown for 33 lesions (69%; P < .0001), with 16 cancers (80%; P < .0001) and 17 benign lesions. Shear wave elastography assisted detection of 3 (19%) cancers on US imaging. All 7 soft US category 3 lesions were benign (7 of 33 [21%]; P = .0014). CONCLUSIONS: Shear wave elastography was useful with targeted US after breast MRI to increase cancer detection by US. A significant number of US correlates to MRI-detected lesions could have been identified as benign (category 3 and soft) before biopsy, with the potential of short-interval follow-up of MRI-detected lesions with benign US correlates instead of biopsy.

Histological Grade and Immunohistochemical Biomarkers of Breast Cancer: Correlation to Ultrasound Features.

OBJECTIVES: The purpose of this study is to correlate various features of breast cancers on ultrasound to their histological grade and immunohistochemical biomarkers. METHODS: Seventy-three patients with 77 invasive breast cancers, diagnosed between August 2011 and December 2014, were included in this prospective analysis. Margin, posterior features, shape, and vascularity were determined from ultrasound and classified according to the Breast Imaging Reporting and Data System lexicon. Histological grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status (positive [+] or negative [-]) were determined from surgical pathology reports. The cancers were categorized into low grade (grades 1 or 2) and high grade (grade 3). Correlation of ultrasound features of the cancers to their histological grade and receptor status was performed. RESULTS: There were 47 low-grade and 29 high-grade cancers. There was a significant difference in margin and posterior features between the low and high grade, ER + and ER-, and PR + and PR- (all P < .05), but not between HER2 + and HER2- cancers (both P > .05). There was no significant difference in shape and vascularity among the different subtypes (all P > .05). Spiculated margin was significantly associated with low-grade, ER+, PR + status; angular margin with high grade; microlobulated margin with ER- status; shadowing with PR + status; and enhancement with high grade, ER- status (all P < .05, all odds ratios ≥ 3.94). CONCLUSIONS: There was significant association of margin and posterior features of breast cancers with their histological grade and receptor status.

Quantitative shear wave elastography: correlation with prognostic histologic features and immunohistochemical biomarkers of breast cancer.

RATIONALE AND OBJECTIVES: To correlate prognostic histologic features and immunohistochemical biomarkers of breast cancer with quantitative shear wave elastography (SWE) parameters. MATERIALS AND METHODS: B-mode ultrasound (US) and SWE were performed before core biopsy on 72 cancers in 68 patients. Mean cancer size was determined from US. Histologic grade, lymph node status, lymphovascular invasion (LVI), histologic type, and immunohistochemical biomarkers (estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 [HER2]) were determined from surgical pathology reports. Correlation between these features and quantitative SWE parameters (mean elasticity [E mean], maximum elasticity [E max], and elasticity ratio [E ratio]) was made. RESULTS: There was significant correlation of mean cancer size with E mean, E max, and E ratio (correlation, 0.492, 0.500, and 0.435, respectively; all P < .001). Lymph node involvement was associated with significantly higher E max (P = .040). LVI was associated with significantly higher E mean, E max, and E ratio (P = .002, .004, and .042, respectively). There was no significant correlation of histologic grade with SWE parameters. HER2+ cancers were associated with significantly higher E ratio (P = .030). In multivariate analysis, only mean cancer size was significantly correlated with E mean and E max (P < .001). CONCLUSIONS: There was significant correlation of cancer size with SWE parameters. There was significant correlation of lymph node status and LVI with SWE, but only on univariate analysis. SWE has the potential to provide prognostic information of breast cancer in a noninvasive manner, but further study is required.

Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors.

OBJECTIVE: The purposes of this article are to review the anatomy of the upper gastrointestinal tract; review techniques and contrast agents used in the fluoroscopic examination of the oropharynx and hypopharynx; provide a pictorial review of some important causes of oropharyngeal dysphagia; and link these causes to key findings in the clinical history to assist in establishing a clinical diagnosis. CONCLUSION: Many important causes and presentations of oropharyngeal dysphagia are sometimes overlooked during conventional upper gastrointestinal studies. Videofluoroscopic evaluation for assessment of both structural abnormalities and motility disorders of the oropharynx by use of various compositions of barium contrast medium is the standard of practice. Using best-practices radiographic techniques and having knowledge of swallowing mechanisms and various diseases are important for assessment of dysphagia. Dynamic fluoroscopic imaging remains an essential tool for assessing functional disorders of swallowing. Detailed videofluoroscopic assessment can guide treatment decisions with the goal of decreasing the secondary complications of dysphagia.

Diagnostic performance of quantitative shear wave elastography in the evaluation of solid breast masses: determination of the most discriminatory parameter.

OBJECTIVE: The purpose of this article is to assess the diagnostic performance of quantitative shear wave elastography in the evaluation of solid breast masses and to determine the most discriminatory parameter. SUBJECTS AND METHODS: B-mode ultrasound and shear wave elastography were performed before core biopsy of 123 masses in 112 women. The diagnostic performance of ultrasound and quantitative shear wave elastography parameters (mean elasticity, maximum elasticity, and elasticity ratio) were compared. The added effect of shear wave elastography on the performance of ultrasound was determined. RESULTS: The mean elasticity, maximum elasticity, and elasticity ratio were 24.8 kPa, 30.3 kPa, and 1.90, respectively, for 79 benign masses and 130.7 kPa, 154.9 kPa, and 11.52, respectively, for 44 malignant masses (p < 0.001). The optimal cutoff value for each parameter was determined to be 42.5 kPa, 46.7 kPa, and 3.56, respectively. The AUC of each shear wave elastography parameter was higher than that of ultrasound (p < 0.001); the AUC value for the elasticity ratio (0.943) was the highest. By adding shear wave elastography parameters to the evaluation of BI-RADS category 4a masses, about 90% of masses could be downgraded to BI-RADS category 3. The numbers of downgraded masses were 40 of 44 (91%) for mean elasticity, 39 of 44 (89%) for maximum elasticity, and 42 of 44 (95%) for elasticity ratio. The numbers of correctly downgraded masses were 39 of 40 (98%) for mean elasticity, 38 of 39 (97%) for maximum elasticity, and 41 of 42 (98%) for elasticity ratio. There was improvement in the diagnostic performance of ultrasound of mass assessment with shear wave elastography parameters added to BI-RADS category 4a masses compared with ultrasound alone. Combined ultrasound and elasticity ratio had the highest improvement, from 35.44% to 87.34% for specificity, from 45.74% to 80.77% for positive predictive value, and from 57.72% to 90.24% for accuracy (p < 0.0001). The AUC of combined ultrasound and elasticity ratio (0.914) was the highest compared with the other combined parameters. CONCLUSION: There was a statistically significant difference in the values of the quantitative shear wave elastography parameters of benign and malignant solid breast masses. By adding shear wave elastography parameters to BI-RADS category 4a masses, we found that about 90% of them could be correctly downgraded to BI-RADS category 3, thereby avoiding biopsy. Elasticity ratio (cutoff, 3.56) appeared to be the most discriminatory parameter.