Uporedna analiza mamografije, ultrasonografije i ultrazvučne elastografije u razlikovanju lezija u dojkama
Comparision of mammography, ultrasonography and ultrasound elastography in the differentiation of breast lesions
Author
Radović, Magdalena R.Mentor
Šaranović, ĐorđijeCommittee members
Granić, MiroslavStević, Ruža

Ivanović, Nebojša
Bogdanović-Stojanović, Dragana
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Show full item recordAbstract
UVOD: U otkrivanju i razlikovanju lezija u dojkama se primenjuje klinički pregled,
radiološka dijagnostika, uglavnom mamografija i ultrasonografija i patohistološka
dijagnostika. Ograničenja palpacije, mamografije i ultrazvuka i potreba da se ne previdi rani
karcinom dojke, doveli su do povećanja broja biopsija, koje se najčešće izvode zbog benignih
lezija. Stoga je razvijena elastografija, kao nova, komplementarna, neinvazivna tehnika, koja
direktno otkriva elastične karakteristike tkiva dojke, koja se razlikuju po tvrdoći, pa invazivni
karcinom ima najnižu elastičnost, a potom neinvazivni karcinom, fibrozno tkivo dojke,
normalno glandularno tkivo, potom masno tkivo dojke i to ovim redom. Elastografska
evaluacija se vrši kvalitativno (Tsukuba elastični skor, TES) i semikvantitativno (odnosom
kompresibilnosti masti i lezije, FLR, SR).
CILJ RADA: Cilj istraživanja je bio da se proceni da li elastografijom, kao novom metodom,
mogu da se postignu bolji rezultati u detekciji i razlikovanju... benignih i malignih lezija, u
odnosu na konvencionalni ultrazvuk i mamografiju i da li kombinacija elastografije i
ultrazvuka ili elastografije, ultrazvuka i mamografije može da poveća pouzdanost
dijagnostike lezija u dojci.
Takođe je cilj bio i da se utvrdi da li postoje neke kliničke osobine bolesnica koji mogu da
utiču na ove dijagnostičke testove.
MATERIJAL I METODE: Istraživanje je obavljeno u KBC „Bežanijska kosa“, u Beogradu
kao jednogodišnja prospektivna studija preseka. Studija je obuhvatila ukupno 128 lezija kod
122 bolesnice (prosečne starosti 54 godine, raspona 21-84 godine) koje su dijagnostikovane
kao benigne ili maligne, mamografijom i ultrazvukom i dalje analizirane elastografijom.
Dijagnostički algoritam je uključivao i klinički pregled, kao prvi test. Mamografija i
ultrazvuk su analizirani i kodirani po BI RADS klasifikaciji. Elastografija je određena
Tsukuba elastičnim skorom (TES), sistemom od 5 kategorija i vrednošću odnosa
kompresibilnosti masnog tkiva i lezije (SR, FLR). Dijagnostički rezultati su poređeni sa
histopatološkim nalazom, kao standardom. Izračunati su senzitivnost, specifičnost, tačnost,
pozitivna i negativna prediktivna vrednost i stepen lažno-pozitivnih i lažno-negativnih nalaza
sa svaki modalitet. Primenili smo ROC analizu u proceni uloge elastografije i drugih
modaliteta i njihovih kombinacija u dijagnosti lezija u dojkama...
INTRODUCTION: Detection and differentiation of brest lesions is performed by clinical
examination, imaging methods, preferably mammography and sonography, and
patohistological diagnostic. Limitations of palpation, mammography and sonography and the
great need not to miss a malignant lesion in the early stage of disease lead to increased rate of
aggressive biopsy, that are mostly performed for benign diseases. Therefore, elastography
developed, as new, complementary, noninvasive method, which directly reveals soft tissue
elasticity. Various breast tissues have different elastic stiffness, as invasive carcinoma having
the lowest elasticity, followed by noninvasive carcinoma, fibrous tissue in the breast, normal
glandular breast tissue, and breast fat tissue in that order. Elasticity assessment consists of
qualitative (Tsukuba elasticity score, TES assessment) and semiquantitative evaluation
(strain ratio between fat and lesion, FLR, SR).
AIM: The goal of this study was to evaluate whethe...r the method of elastography could
improve the detection and differentiation of benign and malignant breast lesions compared
with conventional sonography and mammography and whether the combination of
elastography and sonography or elastography, sonography and mammography could improve
the accuracy of diagnosis of breast lesions. Also, the goal was to determine potential
influence of clinical characteristics to diagnostic methods.
MATERIAL AND METHODS: The investigation was performed from February 2015. to
April 2016, in Clinical Center „Bezanijska kosa“ in Belgrade as one year prospective study.
Study included 128 lesion from 122 consecutive patients (men age, 54 years, range 21-84
years), that were diagnosed as benign or malignant by mammography and sonography and
further analyzed with elastography. Diagnostic algorithm also included clinical breast
examination, as first test. Mammography and sonography were analyzed and classified
according to the BI RADS. Sonoelastography was determined by Tsukuba elasticity score
(TES), with 5-point scoring method and calculation of strain ratio, fat to lesion ratio (SR,
FLR). The diagnostic results were compared with histopathologic findings, as standard
reference. The senzitivity, specificity, accuracy, positive and negative predictive values, and
false-positive and –negative rates were calculated for each modality. We performed ROC
analysis for assessment of the role of elastography and other modalities and their combination
in diagnosis of breast lesions...