Diagnostic Value of Different Risk-Stratification Algorithms in Solid Breast Lesions

In the past few years, elastography has gained ground as a complementary method to ultrasonography in noninvasive breast cancer screening. Despite positive outcomes, there is a further need to refine the method, especially regarding BIRADS scores 3 and 4A, where the distinction between benignancy and malignancy is established. The aim of the present study was to evaluate the best risk-stratification system using both qualitative and semiquantitative elastographic methods for solid breast nodules. A total of 1405 solid nodules, described in 657 female patients, were examined in our endocrine unit between January 2018 and December 2019. The inclusion criterion for our retrospective study was the presence of any solid breast mass in women of all ages (mean, 40.85 ± SD 27.11), detected during ultrasound examination using a HITACHI PREIRUS machine (Hitachi Medical Corporation, Tokyo, Japan). The Breast Imaging Reporting and Data System (BIRADS)–US criteria were used in the assessment of each nodule by conventional US (gray-scale mode) and Doppler evaluation. The Ueno score and strain ratio were also measured for all the described lesions. We considered multiple algorithms for the risk reassessment of solid breast nodules: classical BIRADS–US, EFSUMB BIRADS, worst-case scenario BIRADS and BIRADS TM. There were 93 malignant nodules out of 1405. The diagnosis was based on histopathological results for all the malignant lesions. Benign lesions were diagnosed based on histopathological results, Tru-Cut biopsy, mammography and MRI. The Sensitivity (Se), Specificity (Sp), Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Accuracy (Acc) were obtained for all the proposed risk-stratification reporting systems: conventional BIRADS-US (Se, 74.23%; Sp, 63.95%; PPV, 13.53%; NPV, 97.79%; Acc, 65%); EFSUMB BIRADS (Se, 71.23%; Sp, 81.55%; PPV, 22.68%; NPV, 97.99%; Acc, 81%); worst-case scenario BIRADS (Se, 84.23%; Sp, 58.23%; PPV, 13.29%; NPV, 98.84%; Acc, 60%); BIRADS TM (Se, 81.23%; Sp, 75.84%; PPV, 20.35%; NPV, 98.81%; Acc, 77%). We found that the most efficient risk-stratification reporting system was the proposed one, BIRADS TM, which considers both upgrading and downgrading the conventional BIRADS-US, followed by the worst-case scenario BIRADS and EFSUMB BIRADS.