Mediclinic Comprehensive Cancer Center, City Hospital Dubai
Abstract
B-mode ultrasound is used as an adjunct to mammography to differentiate between benign and malignant breast lesions. An additional ultrasound technique, elastography, can evaluate the stiffness of tissue. It is believed that malignant lesions are generally stiffer than benign lesions. 2D Shear Wave Elastography (2D SWE) is a new elastography method for measuring the stiffness of tissue. Because this method does not depend on the degree of compression, measurements are reliable and reproducible. 2D Shear Wave Elastography (2D SWE) in combination with ultrasonography - has the potential to abnormalities in more detail. Adding elastography to traditional B-mode ultrasound improves the diagnostic specificity without loss of sensitivity. This suggests that Virtual TouchTM 2D Shear Wave Elastography (2D-SWE) might change patient management and avoid unnecessary biopsies. However, further research involving a greater variety of abnormalities and larger study populations is indicated.
Below cases are done in combination of Ultrasound imaging, 2D Shear Wave Elastography (2D SWE), Mammography and MRI Imaging.
Case 1
Patient History: 25-year-old patient with no family history of breast cancer, presents with newly felt lump in right breast (lower outer quadrant) and is not sure of duration. External ultrasound study suspects a 22 x 13mm hypoechoic mass with posterior enhancement and mild vascularity. Core biopsy is advised, and she presents for a 2nd opinion.
Technology used: 2D Shear Wave Elastography (2D SWE)
Virtual TouchTM 2D Shear Wave Elastography (2DSWE) Outcome: Elastography images confirm a hardened lesion(red lateral aspect) with central necrosis (signal void) suggestive of liquefaction/necrosis. Further assessment post-biopsy with 2D-SWE imaging confirms the lesion to reveal exaggerated hypoechoic margin beyond visible boundary, confirming adjacent hardened/ infiltrated parenchyma.
Clinical Findings
Fig. 1A - B-mode ultrasound image, Fig. 1B 2D Shear Wave Elastography (2D SWE) image with color map and shear velocities, shows hardened tissue with red color presentation with high velocities. Image with 2D Shear Wave Elastography (2D SWE) shows infiltration beyond identified boundaries, presentation is with black and white scale map.
Case 2
Patient History: 53-year-old patient complained of a tender solid mass newly identified in her left breast at 15:00 hrs.
Technology used: 2D Shear Wave Elastography (2D SWE)
Clinical Findings
Ultrasound reveals rounded ovoid mass with internal echoes and posterior transmission - features suggestive of complicated cyst but differential included a fibroadenoma.
Fig. 4A - B-mode ultrasound, shows well circumscribed darkly hypoechoic mass with internal echogenic foci.
Case 3
Patient History: Missed cancer - externally presumed fibroadenoma.
Patient Age: 42-year-old - No family history of cancer.
Clinical Findings
Unifocal well marginated triangular mass, very posterior on upper RMLO was presumed to represent a benign mass. Patient sought 2nd opinion.US reveals irregular lobulated hypoechoic mass in right upper inner quadrant adjacent to the pectoral muscle with echogenic margin.
Fig. 5A RMLO mammo with triangular density overlying the pectoral muscle in the upper aspect.
Fig. 5B Two dimensional imaging shows irregular circumscribed hypoechoic mass with echogenic margin adjacent to pectoral muscle.
Case 4
Patient History: 45-year-old patient with long standing mass RUOQ suspected in 2015 to represent fibroadenoma, annually same size and appearance but now patient feels that the lesion has recently started to grow.
Technology used: Virtual touch 2D Shear Wave Elastography(2D-SWE) elastography.
Virtual touch 2D Shear Wave Elastography (2D-SWE) Outcome: 2D-SWE imaging reveal soft lesion on elastography.
Clinical Findings
Fig. 6A and Fig. 6B Right MLO and RCC reveal a well-defined, partially lobulated 2.2cm hypoechoic mass in the RUOQ with no micro calcifications.
