Search

Patients with triple‐negative breast cancer (TNBC) exhibit a fast tumor growth rate and poor survival outcomes. In this study, we aimed to develop and compare intelligent algorithms using ultrasound radiomics features in addition to clinical variables to identify patients with TNBC prior to histopathologic diagnosis. We used single‐center, retrospective data of patients who underwent ultrasound before histopathologic verification and subsequent neoadjuvant systemic treatment (NAST). We developed a logistic regression with an elastic net penalty algorithm using pretreatment ultrasound radiomics features in addition to patient and tumor variables to identify patients with TNBC. Findings were compared to the histopathologic evaluation of the biopsy specimen. The main outcome measure was the area under the curve (AUC). We included 1161 patients, 813 in the development set and 348 in the validation set. Median age was 50.1 years and 24.4% (283 of 1161) had TNBC. The integrative model using radiomics and clinical information showed significantly better performance in identifying TNBC compared to the radiomics model (AUC: 0.71, 95% confidence interval [CI]: 0.65–0.76 versus 0.64, 95% CI: 0.57–0.71, P= .004). The five most important variables were cN status, shape surface volume ratio (SA:V), gray level co‐occurrence matrix (GLCM) correlation, gray level dependence matrix (GLDM) dependence nonuniformity normalized, and age. Patients with TNBC were more often categorized as BI‐RADS 4 than BI‐RADS 5 compared to non‐TNBC patients (P= .002). A machine learning algorithm showed promising potential to identify patients with TNBC using ultrasound radiomics features and clinical information prior to histopathologic evaluation.

Shear wave elastography (SWE) is increasingly used in breast cancer diagnostics. However, large, prospective, multicenter data evaluating the reliability of SWE is missing. We evaluated the intra‐ and interobserver reliability of SWE in patients with breast lesions categorized as BIRADS 3 or 4. We used data of 1288 women at 12 institutions in 7 countries with breast lesions categorized as BIRADS 3 to 4 who underwent conventional B‐mode ultrasound and SWE. 1243 (96.5%) women had three repetitive conventional B‐mode ultrasounds as well as SWE measurements performed by a board‐certified senior physician. 375 of 1288 (29.1%) women received an additional ultrasound examination with B‐mode and SWE by a second physician. Intraclass correlation coefficients (ICC) were calculated to examine intra‐ and interobserver reliability. ICC for intraobserver reliability showed an excellent correlation with ICC >0.9, while interobserver reliability was moderate with ICC of 0.7. There were no clinically significant differences in intraobserver reliability when SWE was performed in lesions categorized as BI‐RADS 3 or 4 as well as in histopathologically benign or malignant lesions. Reliability of additional SWE was evaluated on a study cohort consisting of 1288 breast lesions categorized as BI‐RADS 3 and 4. SWE shows an excellent intraobserver reliability and a moderate interobserver reliability in the evaluation of solid breast masses. Access the CME test hereand search by article title.

We evaluated whether lesion‐to‐fat ratio measured by shear wave elastography in patients with Breast Imaging Reporting and Data System (BI‐RADS) 3 or 4 lesions has the potential to further refine the assessment of B‐mode ultrasound alone in breast cancer diagnostics. This was a secondary analysis of an international diagnostic multicenter trial (NCT02638935). Data from 1288 women with breast lesions categorized as BI‐RADS 3 and 4a–c by conventional B‐mode ultrasound were analyzed, whereby the focus was placed on differentiating lesions categorized as BI‐RADS 3 and BI‐RADS 4a. All women underwent shear wave elastography and histopathologic evaluation functioning as reference standard. Reduction of benign biopsies as well as the number of missed malignancies after reclassification using lesion‐to‐fat ratio measured by shear wave elastography were evaluated. Breast cancer was diagnosed in 368 (28.6%) of 1288 lesions. The assessment with conventional B‐mode ultrasound resulted in 53.8% (495 of 1288) pathologically benign lesions categorized as BI‐RADS 4 and therefore false positives as well as in 1.39% (6 of 431) undetected malignancies categorized as BI‐RADS 3. Additional lesion‐to‐fat ratio in BI‐RADS 4a lesions with a cutoff value of 1.85 resulted in 30.11% biopsies of benign lesions which correspond to a reduction of 44.04% of false positives. Adding lesion‐to‐fat ratio measured by shear wave elastography to conventional B‐mode ultrasound in BI‐RADS 4a breast lesions could help reduce the number of benign biopsies by 44.04%. At the same time, however, 1.98% of malignancies were missed, which would still be in line with American College of Radiology BI‐RADS 3 definition of <2% of undetected malignancies.

The BI‐RADS classification provides a standardized way to describe ultrasound findings in breast cancer diagnostics. However, there is little information regarding which BI‐RADS descriptors are most strongly associated with malignancy, to better distinguish BI‐RADS 3 (follow‐up imaging) and 4 (diagnostic biopsy) breast masses. Patients were recruited as part of an international, multicenter trial (NCT02638935). The trial enrolled 1294 women (6 excluded) categorized as BI‐RADS 3 or 4 upon routine B‐mode ultrasound examination. Ultrasound images were evaluated by three expert physicians according to BI‐RADS. All patients underwent histopathological confirmation (reference standard). We performed univariate and multivariate analyses (chi‐square test, logistic regression, and Krippendorff's alpha). Histopathologic evaluation showed malignancy in 368 of 1288 masses (28.6%). Upon performing multivariate analysis, the following descriptors were significantly associated with malignancy (P< .05): age ≥50 years (OR 8.99), non‐circumscribed indistinct (OR 4.05) and microlobulated margin (OR 2.95), nonparallel orientation (OR 2.69), and calcification (OR 2.64). A clinical decision rule informed by these results demonstrated a 97% sensitivity and missed fewer cancers compared to three physician experts (range of sensitivity 79–95%) and a previous decision rule (sensitivity 59%). Specificity was 44% versus 22–83%, respectively. The inter‐reader reliability of the BI‐RADS descriptors and of the final BI‐RADS score was fair‐moderate. A patient should undergo a diagnostic biopsy (BI‐RADS 4) instead of follow‐up imaging (BI‐RADS 3) if the patient is 50 years or older or exhibits at least one of the following features: calcification, nonparallel orientation of mass, non‐circumscribed margin, or posterior shadowing. Access the CME test hereand search by article title.