Value of real-time tissue elastography diffusion quantitative analysis combined with tumor markers for differential diagnosis of benign and malignant breast nodules

Ling Zhu; Lina  Mei; Xuekui  Pan

doi:10.2298/VSP230130077Z

Ling Zhu Huzhou Maternal and Child Health Hospital, *Department of Ultrasound, Zhejiang Province, China
Lina Mei Huzhou Maternal and Child Health Hospital, †Department of Internal Medicine, Huzhou, Zhejiang Province, China
Xuekui Pan Huzhou Maternal and Child Health Hospital, *Department of Ultrasound, Huzhou, Zhejiang Province, China

DOI: https://doi.org/10.2298/VSP230130077Z

Keywords: breast, neoplasms;, biomarkers, tumor;, diagnosis, differential;, elasticity imagine techniques;, sensitivity and specificity.

Abstract

Background/Aim. Serum tumor markers (TMs) are commonly combined with imaging examinations to differentiate benign and malignant breast nodules (BNs), but there are still limitations. The aim of the study was to determine the value of real-time tissue elastography (RTE) diffusion quantitative analysis combined with serum TMs for the differential diagnosis of benign and malignant BNs. Methods. A total of 149 patients with BNs were included in this study. They were assigned to the benign BN group (n = 87) and malignant BN group (n = 62). All patients were examined using RTE diffusion quantitative analysis. Venous blood was collected to detect the levels of TMs carcinoembryonic antigen-CAE, cancer antigen (CA) 153, and CA 199. The value of RTE diffusion quantitative analysis parameters, TMs, and their combination for the differentiation of benign and malignant BNs was analyzed using the receiver operating characteristic-ROC curve. Results. Among all the above indicators, the area ratio of the blue region (AREA%) had the highest differential value, with an area under the curve (AUC) of 0.916 [95% confidence interval (CI): 0.812–0.967], while sensitivity and specificity were 88.90% and 86.79%, respectively (p < 0.05). Compared to RTE diffusion quantitative analysis parameters or TMs alone, the combination of the two showed the highest value for the differentiation of benign and malignant BNs, with an AUC of 0.957 (95% CI: 0.834–0.982), while sensitivity and specificity were 95.50% and 94.33%, respectively (p < 0.05). Conclusion. RTE diffusion quantitative analysis combined with TMs has a high value for the differentiation of benign and malignant BNs.

References

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71(3): 209–49.

Maajani K, Jalali A, Alipour S, Khodadost M, Tohidinik HR, Yazdani K. The global and regional survival rate of women with breast cancer: A systematic review and meta-analysis. Clin Breast Cancer 2019; 19(3): 165–77.

3Lei S, Zheng R, Zhang S, Chen R, Wang S, Sun K, et al. Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030. Cancer Biol Med 2021; 18(3): 900–9.

Zhang D, Jiang F, Yin R, Wu GG, Wei Q, Cui XW, et al. A Review of the Role of the S-Detect Computer-Aided Diagnostic Ultrasound System in the Evaluation of Benign and Malignant Breast and Thyroid Masses. Med Sci Monit 2021; 27: e931957.

Izzo L, Izzo S, Di Poce I, Di Cello P, Di Sero S, Pasquali V, et al. Role of elastosonography in the differentiation between benign and malignant neoformations of the breast and possibility of reducing the number of FNACS for tissue characterization. Clin Ter 2021; 172(4): 305–14.

Moon JH, Koh SH, Park SY, Hwang JY, Woo JY. Comparison of the SRmax, SRave, and color map of strain-elastography in differentiating malignant from benign breast lesions. Acta Radiol 2019; 60(1): 28–34.

Liu J, Wu JP, Wang N, Li GH, Wang XH, Wang Y, et al. Value of Elastography Strain Ratio Combined with Breast Ultrasound Imaging Reporting and Data System in the Diagnosis of Breast Nodules. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2021; 43(1): 63–8. (Chinese)

Uygur MM, Gümüş M. The utility of serum tumor markers CEA and CA 15-3 for breast cancer prognosis and their association with clinicopathological parameters. Cancer Treat Res Commun 2021; 28: 100402.

Hong R, Sun H, Li D, Yang W, Fan K, Liu C, et al. A review of biosensors for detecting tumor markers in breast cancer. Life (Basel) 2022; 12(3): 342.

Pei S, Zhang B, Cong S, Liu J, Wu S, Dong Y, et al. Ultrasound Real-Time Tissue Elastography Improves the Diagnostic Performance of the ACR Thyroid Imaging Reporting and Data System in Differentiating Malignant from Benign Thyroid Nodules: A Summary of 1525 Thyroid Nodules. Int J Endocrinol 2020; 2020: 1749351.

Annaç G, Canyiğit M, Tan S, Akşam E, Süngü Adıyaman N, Arslan H. Differentiation of benign and malignant superficial soft tissue lesions using real-time strain elastography. Turk J Med Sci 2021; 51(6): 2959–67.

Zhang G, Tang Y, Yu H, Kong W, Chen Y, Liu Y, et al. Real-Time Tissue Elastography to Evaluate Hepatic Hypoxic-Ischemic Injury Caused by Brain Death. Ultrasound Q 2021; 37(2): 138–43.

Kobayashi Y, Omichi K, Kawaguchi Y, Arita J, Akamatsu N, Kaneko J, et al. Intraoperative real-time tissue elastography during laparoscopic hepatectomy. HPB (Oxford) 2018; 20(1): 93–9.

Kobayashi K, Nakao H, Nishiyama T, Lin Y, Kikuchi S, Kobayashi Y, et al. Diagnostic accuracy of real-time tissue elastography for the staging of liver fibrosis: a meta-analysis. Eur Radiol 2015; 25(1): 230–8.

Xu Y, Bai X, Chen Y, Jiang L, Hu B, Hu B, et al. Application of Real-time Elastography Ultrasound in the Diagnosis of Axillary Lymph Node Metastasis in Breast Cancer Patients. Sci Rep 2018; 8(1): 10234.

Fang C, Yang TWYZJXW. Value of tissue elastography in the prediction of efficacy of neoadjuvant chemotherapy in breast cancer. J BUON 2019; 24(2): 555–9.

Luo J, Xiao J, Yang Y, Chen G, Hu D, Zeng J. Strategies for five tumour markers in the screening and diagnosis of female breast cancer. Front Oncol 2023; 12: 1055855.

Can C, Arac E, Cakabay B, Guzel Y. The relationship between CEA and CA 15-3 positivity and metabolic and volumetric 18F-FDG PET/CT parameters in preoperative evaluation of breast cancer. Ann Ital Chir 2022; 92: 33–9.

Gielen J, Vanhoenacker F, Ceulemans R, Van Holsbeeck M, Van der Woude HJ, Verstraete KL, et al. Ultrasound and color Doppler ultrasound of soft tissue tumors and tumorlike lesions. In: Vanhoenacker F, Parizel P, Gielen J, editors. Imaging of soft tissue tumors. Cham: Springer International Publishing; 2017. pp. 3–40.

Guo J, Liang L, Zhou N, Li DY. Quantitative analysis of ultrasound tissue diffusion elastography in the diagnosis of benign and malignant prostate lesions. Urol J 2019; 16(4): 347–51.

Egnell L, Vidić I, Jerome NP, Bofin AM, Bathen TF, Goa PE. Stromal collagen content in breast tumors correlates with in vivo diffusion-weighted imaging: a comparison of multi b-value DWI with histologic specimen from benign and malignant breast lesions. J Magn Reson Imaging 2020; 51(6): 1868–78.

Han J, Sun P, Sun Q, Xie Z, Xu L, Hu X, et al. Quantitative ultrasound parameters from scattering and propagation may reduce the biopsy rate for breast tumor. Ultrasonics 2024; 138: 107233.

Yildirim D, Akıncı Ö, Tekcan DE. Quantitative ultrasound elastography of breast: a review and update with emphasis on shear wave imaging (ARFI). Open J Med Imaging 2021; 11(2): 58–72.

Gong X, Xu Q, Xu Z, Xiong P, Yan W, Chen Y. Real-time elastography for the differentiation of benign and malignant breast lesions: a meta-analysis. Breast Cancer Res Treat 2011; 130(1): 11–8.