RSNA: Elastography + ultrasound could avoid unnecessary biopsies
CHICAGO--Elastography, when added to breast ultrasound, could help distinguish cancerous from benign lesions and avoid unnecessary biopsies, according to a study presented Monday at the Radiological Society of North America (RSNA) annual meeting.

“We can clearly try to find better detection methods to identify breast cancer earlier,” said Stamatia Destounis, MD, a radiologist at Elizabeth Wende Breast Care of Rochester, N.Y., and lead author of the study. Destounis noted that the American Cancer Society has determined that approximately 80 percent of breast lesions biopsied turn out to be benign.

“Elastography could potentially decrease the need to perform a biopsy, or it could reduce the need for increased imaging of benign lesions,” she said, “thus reducing the anxiety and stress on the patient, and also the financial hardship that unnecessary biopsy procedures can cost.”

Elastography is a technique through which a radiologist can measure the elasticity of tissue. The value of such a technique, according to Destounis, is that cancerous tumors tend to be stiffer than the surrounding healthy tissue, which means a more compressible lesion on elastography is less likely to be malignant.

In what is an ongoing study, 193 patients (ages ranging from 18 to 91, with an average age of 54) at Elizabeth Wende underwent breast ultrasound and elastography. Researchers found 198 lesions, meaning some patients had more than one abnormality.

According to Destounis, the use of ultrasound and elastography enabled the researchers to identify 58 lesions that did not require biopsies. Of the remaining lesions that were biopsied, 59 were cancerous, 69 were benign.

The researchers found that of the 59 cancerous lesions confirmed by biopsy, the use of elastography identified 58 of them, or 98 percent. Of the 69 benign findings, elastography was able to identify 78 percent of them.

“Obviously this needs much more work or research, but it could in the near future impact the decision whether or not to perform a biopsy in some of these benign cases,” said Destounis. “Women are becoming more and more concerned about unnecessary procedures and unnecessary biopsies and I think this may be an additional tool that we can use, particularly for some of the benign findings."

Destounis pointed out that while elastography has been “around for quite a while, the software has been age-improved and it has seen a resurgence in the last five or ten years, especially for small parts like prostate, thyroid or breast.”

She said she is seeing more vendors working on their product and that more breast imagers will become interested in using the technique.