Mehmet Sedat DURMAZ, Yaşar ÜNLÜ, Ayşegül ALTUNKESER, Serdar ARSLAN, Fatih ÖNCÜ, Mehmet Ali ERYILMAZ

Advantages of b-mode ultrasound combined with strain elastography in differentiation of idiopathic granulomatous mastitis from malignant breast lesions

Background/aim: To evaluate the diagnostic performance of strain elastography (SE) combined with B-mode ultrasound indistinguishing between idiopathic granulomatous mastitis (IGM) and malignant breast lesions.Materials and methods: Seventy-seven malignant breast lesions and 36 IGM were assessed using B-mode ultrasound and SE.Ultrasonographic findings for all the breast lesions were classified based on the 2013 American College of Radiology Breast ImagingReporting and Data System (BI-RADS-US), and the SE findings were evaluated based on the strain ratio and a five-point scale. Thediagnostic performances of B-mode ultrasonography, SE, and the combination of both methods were compared.Results: Significant differences in strain ratio and elastography scores were found between IGM and malignant breast lesions. Whenthe lesions were assessed with B-mode ultrasound alone, in order to distinguish between IGM and malignant breast lesions, sensitivity,specificity, positive predictive value, negative predictive value, and accuracy were 94.8%, 66.7%, 85.9%, 85.7%, and 85.8%, respectively.However, when assessed with a combination of B-mode ultrasonography and SE, sensitivity, specificity, positive predictive value,negative predictive value, and accuracy were 96.1%, 100%, 100%, 92.3%, and 97.3%, respectively.Conclusion: The combination of SE and B-mode ultrasound has better diagnostic performance in the differentiation of IGM andmalignant breast lesions than B-mode ultrasonography alone.

PDF

___

Bani-Hani KE, Yaghan RJ, Matalka, II, Shatnawi NJ. Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. Breast J 2004; 10: 318-322.
Aghajanzadeh M, Hassanzadeh R, Alizadeh Sefat S, Alavi A, Hemmati H, Esmaeili Delshad MS, Emir Alavi C, Rimaz S, Geranmayeh S, Najafi Ashtiani M et al. Granulomatous mastitis: presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran. Breast 2015; 24: 456-460.
Han BK, Choe YH, Park JM, Moon WK, Ko YH, Yang JH, Nam SJ. Granulomatous mastitis: mammographic and sonographic appearances. Am J Roentgenol 1999; 173: 317-320.
Hovanessian Larsen LJ, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. Am J Roentgenol 2009; 193: 574-581.
Gautier N, Lalonde L, Tran-Thanh D, El Khoury M, David J, Labelle M, Patocskai E, Trop I. Chronic granulomatous mastitis: Imaging, pathology and management. Eur J Radiol 2013; 82: 165-175.
Aslan H, Pourbagher A, Çolakoğlu T. Idiopathic granulomatous mastitis: magnetic resonance imaging findings with diffusion MRI. Acta Radiol 2016; 57: 796-801.
American College of Radiology. ACR BI-RADS-US. In: ACR Breast Imaging Reporting and Data System. 5th ed. Reston, VA, USA: American College of Radiology, 2013. p.171.
Gokalp G, Topal U, Kizilkaya E. Power Doppler sonography: anything to add to BI-RADS US in solid breast masses? Eur J Radiol 2009; 70: 77-85.
Durur-Karakaya A, Durur-Subasi I, Akcay MN, Sipal S, Guvendi B. Sonoelastography findings for idiopathic granulomatous mastitis. Jpn J Radiol 2015; 33: 33-38.
Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, Yamakawa M, Matsumura T. Breast disease: clinical application of US elastography for diagnosis. Radiology 2006; 239: 341- 350.
Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol 1972; 58: 642-646.
Cakir B, Tuncbilek N, Karakas HM, Unlu E, Ozyılmaz F. Granulomatous mastitis mimicking breast carcinoma. Breast J 2002; 8: 251-252.
Erhan Y, Veral A, Kara E, Ozdemir N, Kapkac M, Ozdedeli E, Yilmaz R, Koyuncu A, Erhan Y, Ozbal O. A clinicopthologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast 2000; 9: 52-56.
Memis A, Bilgen I, Ustun EE, Ozdemir N, Erhan Y, Kapkac M. Granulomatous mastitis: imaging findings with histopathologic correlation. Clin Radiol 2002; 57: 1001-1006.
Patel RA, Strickland P, Sankara IR, Pinkston G, Many W Jr, Rodriguez M. Idiopathic granulomatous mastitis: case reports and review of literature. J Gen Intern Med 2010; 25: 270-273.
Seo HR, Na KY, Yim HE, Kim TH, Kang DK, Oh KK, Kang SY, An YS, Chun M, Kim W et al. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer 2012; 15: 111-118.
Boufettal H, Essodegui F, Noun M, Hermas S, Samouh N. Idiopathic granulomatous mastitis: a report of twenty cases. Diagn Interv Imaging 2012; 93: 586-596.
Yildiz S, Aralasmak A, Kadioglu H, Toprak H, Yetis H, Gucin Z, Kocakoc E. Radiologic findings of idiopathic granulomatous mastitis. Med Ultrason 2015; 17: 39-44.
Fazzio RT, Shah SS, Sandhu NP, Glazebrook KN. Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging 2016; 7: 531-539.
Lee JH, Oh KK, Kim EK, Kwack KS, Jung WH, Lee HK. Radiologic and clinical features of idiopathic granulomatous lobular mastitis mimicking advanced breast cancer. Yonsei Med J 2006; 47: 78-84.
Yilmaz R, Demir AA, Kaplan A, Sahin D, Ozkurt E, Dursun M, Acunas G. Magnetic resonance imaging features of idiopathic granulomatous mastitis: is there any contribution of diffusionweighted imaging in the differential diagnosis? Radiol Med 2016; 121: 857-866.
Timmers JM, van Doorne-Nagtegaal HJ, Zonderland HM, van Tinteren H, Visser O, Verbeek AL, den Heeten GJ, Broeders MJ. The Breast Imaging Reporting and Data System (BIRADS) in the Dutch breast cancer screening programme: its role as an assessment and stratification tool. Eur Radiol 2012; 22: 1717-1723.
Teke M, Teke F, Alan B, Turkoglu A, Hamidi C, Goya C, Hattapoglu S, Gumus M. Differential diagnosis of idiopathic granulomatous mastitis and breast cancer using acoustic radiation force impulse imaging. J Med Ultrason 2017; 44: 109- 115.
Mori M, Tsunoda H, Kawauchi N, Kikuchi M, Honda S, Suzuki K, Yamauchi H. Elastographic evaluation of mucinous carcinoma of the breast. Breast Cancer 2012; 19: 60-63.
Su X, Lin Q, Cui C, Xu W, Wei Z, Fei J, Li L. Non-calcified ductal carcinoma in situ of the breast: comparison of diagnostic accuracy of digital breast tomosynthesis, digital mammography, and ultrasonography. Breast Cancer. 2017; 24: 562-570.
Chang JM, Won JK, Lee KB, Park IA, Yi A, Moon WK. Comparison of shear-wave and strain ultrasound elastography in the differentiation of benign and malignant breast lesions. Am J Roentgenol 2013; 201: 347-356.