Evaluation of Focal Breast Lesions Using Ultrasound Elastography with Fnac and /Or Histopathology Correlation Among Patients Visiting Breast Ultrasound and Mammography Unit Radiology Department of Tikur Anbesa Specialized Hospital
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Date
2025-07-01
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Addis Ababa University
Abstract
Background: Breast cancer is one of the most common causes of illness and death in Ethiopia and worldwide. In Ethiopia, diagnosis has usually relied on clinical palpation, mammography, and B-mode ultrasonography (US). Biopsy is still the best method for a definitive diagnosis. Recently, elastography has emerged as a useful tool alongside B-mode US. It improves specificity and helps in the early detection of breast cancer. By determining the need for biopsy procedures, elastography reduces both false-positive and unnecessary outcomes. However, it is still largely unexplored in Ethiopian clinical practice. This study aimed to examine the impact of ultrasound elastography on characterizing breast lesions and reducing unnecessary biopsies in our context. Methodology: From January 1 to April 30, 2025, we conducted a prospective analytical cross-sectional study at Tikur Anbessa Specialized Hospital (TASH) to evaluate focal breast and post mastectomy chest wall lesions using ultrasound elastography. We correlated the results with fine needle aspiration cytology (FNAC) or core needle biopsy (CNB). We used structured checklists based on the ACR BI-RADS guidelines to collect data. A single radiologist trained in breast elastography acquired the images. The data was analyzed using IBM SPSS version 25. Result: In this study100 patients were included and among this 72% had malignant lesions, 26% had benign lesions, and 2% showed atypical findings. The most common malignant lesion was invasive carcinoma and most common benign lesion was fibroadenoma. ROC analysis revealed that the BI-RADS classification alone had excellent sensitivity at 98.6% but poor specificity at 10.7%. Including elasticity scoring and strain ratio significantly improved diagnostic accuracy. Elasticity scoring had a sensitivity of 96% and a specificity of 68%. The strain ratio achieved 97.2% sensitivity and 57.2% specificity. When all three methods were used together, parallel testing resulted in perfect sensitivity and negative predictive value at 100%, but very low specificity at 4.3%. The serial testing method provided more balanced outcome, with 91.3% sensitivity, 87.7% specificity, and an overall accuracy of 91%. This suggests serial testing method has superior clinical value in reducing false positives. Conclusion: These findings shows that the clinical importance of combining the BI-RADS category, elasticity score, and strain ratio during ultrasound diagnosis of breast lesions. The results support using multiparametric ultrasound techniques in routine practice to improve diagnostic accuracy, decrease unnecessary biopsies, and optimize patient management. Regular uses of elastography, especially in resource-limited areas help resolve diagnostic challenges.
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Keywords
Breast cancer, Elastography, BI-RADS, Strain ratio, Elasticity score, Diagnostic performance