Characterization of Cystic Breast Masses on Ultrasound: Comparative Study among Conventional, Tissue Harmonic, Compound, and a Combination of Tissue Harmonic and Compound Imaging.

Choo,  Ji Yung; Seo,  Bo Kyoung; Yi,  Ann; Kim,  Hee Young; Cho,  Kyu Ran; Woo,  Ok Hee; Son,  Gil Soo; Kim,  Baek Hyun

Journal of Korean Society of Ultrasound in Medicine 2010;29(4): 271-279.

Ji Yung Choo, Bo Kyoung Seo, Ann Yi, Hee Young Kim, Kyu Ran Cho, Ok Hee Woo, Gil Soo Son, Baek Hyun Kim

¹Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea. seoboky@korea.ac.kr
²Department of Biostatistics, Institute of Economics, Korea University, Seoul, Korea.
³Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
⁴Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
⁵Department of General Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.

Published online: December 1, 2010.

ABSTRACT

PURPOSE: This prospective study was to compare the image quality and diagnostic performance of breast cystic masses by conventional and advanced ultrasound (US) techniques including tissue harmonic, compound, and the combination of these techniques. MATERIALS AND METHODS: All 91 patients, collectively having 109 breast cystic masses were scanned using four US techniques (complicated cysts in 36, septated cysts in 33, and complex cysts in 40). Two breast radiologists independently assessed the image quality and possibility of malignancy. Image quality was evaluated in terms of contrast and clarity of the wall and internal echo pattern and then graded on a scale of 1 (poor) to grade 3 (satisfactory). The possibility of malignancy was graded on a scale of 1 (suggestive of benignancy) to 5 (suggestive of malignancy) using US images. The histopathological results and follow-up images were used as the reference standard for the assessment of diagnostic performance. Results were evaluated by Friedman's test and receiver operating characteristic (ROC) analyses. RESULTS: In terms of image quality, a grade of 3 was significantly more frequent in the three advanced US techniques than conventional US (p < 0.05). For assessment of diagnostic performance, areas under the ROC curves in three advanced techniques were significantly higher than in conventional US (p < 0.05). CONCLUSION: Advanced US techniques including compound and tissue harmonic US techniques provide a better image quality in breast cystic masses and also improve the diagnostic performance compared with conventional US.

Keywords: Breast; Ultrasound; Breast cysts; Ultrasound technology; Ultrasound comparative study