Magdalena Radovic, MD, PhD Benign Malignant -The most frequent - - PowerPoint PPT Presentation

Magdalena Radovic, MD, PhD

Benign

• Incidence clinical 50%,

histological 90%

• Increasing from 20 yrs, peak in 40

and 50 yrs

• Nonproliferative lesions

(no risk)

• Proliferative lesions without

atypical hyperplasia (1.5-2 times)

• Atypical hyperplasia(3.5-5 times)

Malignant

• The most frequent female

malignancy-25% of all malignancies

• The frequent cause of death in

female population-15%

• Increasing incidence from 35yrs of

life

• Incidence: 68/100.000
• Mortality: 20/100.000
• Serbia in Europe- 2. place

(mortality) and 18. place (incidence) in brest cancer statistics

Objective

The purpose of this study was to evaluate the value of

ultrasound elastography (UE) in differentiating benign versus malignant lesions in the breast and

compare it with conventional sonography and mammography

Literature data*

Clinical breast examination Ultrasound Mammography MR exam

sensitivity 60-85% 68-98% 68-85% 90% specificity 60-70% 73% 90% 75% PPV 75% 52% 70% 44%-66% NPV 86% 88.3% 98-100%

*Zhi H. J Ultrasound Med.2007.

A total of 128 breast lesions (73 malignant and 55 benign) in 125 women (mean age 54 years, range 21-84 yrs) were enrolled in this one year prospective study that was conducted in Clinical Center “Bezanijska kosa” in Belgrade.

1.

Clinical Breast Examination (CBE)

2.

Questionnaire

3.

Mammography

4.

Ultrasound

5.

Sonoelastography

6.

Pathohistological result

X SD Age 54.79 14.71

Method

Definitive pathohistology

Nonproliferative lesions Proliferative lesions without atypia Proliferative lesions with atypia Malignant lesions

p= 0.03

Benign lesions at premenopausal patients-52.7% Malignant lesions in postmenopuausal patients-67.1%

p= 0.009 p= 0.002

Mammography as diagnostic tool

Sensitivity 97.3% Specificity 41.9 % False-negative rate 2.7 % False-positive rate 50.9 % PPV 71.7 % NPV 93.1 % Accuracy 76.7 %

RESULTS

Ultrasonography as diagnostic tool

Sensitivity 100 % Specificity 21.8 % False-negative rate 0 % False-positive rate 78.2 % PPV 62.9 % NPV 100 % Accuracy 66.4 %

RESULTS

Results for TES

Sensitivity 95 % Specificity 61.8 % False-negative rate 5 % False-postive rate 28.2 % PPV 76.9 % NPV 91.9 % Accuracy 81.3 % Sensitivity 97.3 % Specificity 55.6 % False-negative rate 2.7 % False-postive rate 44.7 % PPV 74.7 % NPV 93.8 % Accuracy 78.9 %

Results for SR

RESULTS

Sensitivity Specificity False-negative False-positive PPV NPV Accuracy CBE 75% 33% 25% 67% 59% 50% 57% Ultrasound 100% 21.8% 0% 78.2% 62.9% 100% 66.4% TES 95% 61.8% 5% 28.2% 76.9% 91.9% 81.3% SR 63% 81.5% 34.3% 18.5% 82.8% 63.8% 56.2% Mammography 97.3% 41.9% 2.7% 50.9% 71.7% 93.1% 76.7%

Comparison of Sensitivity, Specificity, Accuracy,false-negative, false- positive rate, PPV, NPV and accuracy for diagnostic tools

RESULTS

ROC curve for TES and SR

AUC p CI 95% TES 0.866 < 0.001 0.797-0.934 SR 0.820 0.742-0.898 TES and SR 0.874 0.807-0.941

ROC curve for ultrasound and TES

AUC p CI 95% TES 0.866 < 0.001 0.797-0.934 US 0.905 0.853-0.958 TES and US 0.949 0.912-0.987

ROC curve for mammography, ultrasound and i elastography (TES)

AUC p CI 95% TES 0.866 < 0.001 0.797-0.934 US 0.905 0.853-0.958 Mammography 0.849 0.784-0.914 Mammography, US and TES 0.957 0.924-0.990

TES 3 SR 1.98 Benign-FCC

Ca mucinosum TES 3 SR 5.11

TES 5 SR 8.53 Ca mucinosum

TES 5-IDC

TES 5 IDC, triple neg.

Take away message

The best results in differentiation of benign

versus malignant lesions have combination of all diagnostic modalities.