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Interobserver variability of ultrasound elastography: how it affects the diagnosis of breast lesions

 Jung Hyun Yoon  ;  Myung Hyun Kim  ;  Eun-Kyung Kim  ;  Hee Jung Moon  ;  Jin Young Kwak  ;  Min Jung Kim 
 AMERICAN JOURNAL OF ROENTGENOLOGY, Vol.196(3) : 730-736, 2011 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Area Under Curve ; Biopsy, Needle ; Breast Neoplasms/diagnostic imaging* ; Elasticity Imaging Techniques/methods* ; Humans ; Middle Aged ; Observer Variation ; Predictive Value of Tests ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography, Interventional* ; Ultrasonography, Mammary*
BI-RADS ; breast ; elastography ; interobserver variability ; ultrasound
OBJECTIVE: The purpose of this article is to evaluate the interobserver variability of elastography on real-time ultrasound and how it influences the agreement of final assessment on ultrasound. SUBJECTS AND METHODS: From April to May 2009, 65 breast lesions of 53 patients (mean age, 42.6 years; range, 18-72 years) who underwent ultrasound-guided core biopsy were included in this study. Ultrasound and elastography images of the lesion subjected to biopsy were obtained and prospectively analyzed by three radiologists with individual real-time image scanning prior to biopsy. Each radiologist recorded final ultrasound BI-RADS assessments using ultrasound and combined ultrasound and elastography and the fat-to-lesion ratio and elasticity score. The histopathologic results obtained from ultrasound-guided core biopsy or excision were used as the reference standard. Diagnostic performances and interobserver agreement were analyzed. RESULTS: Of the 65 lesions, 43 (66.2%) were benign, and 22 (33.8%) were malignant. Specificity (20.2-33.3%), positive predictive value (38.7-45.1%), and accuracy (46.7-55.4%) were significantly improved in combined ultrasound and elastography (p < 0.001). Area under the curve (AUC) values for all three performers did not show significant differences in ultrasound (AUC, 0.959) and combined ultrasound and elastography (AUC, 0.957) (p = 0.92). Interobserver agreement was not improved with combined ultrasound and elastography (κ = 0.25) in comparison to ultrasound only (κ = 0.37). Interobserver agreement of real-time elastography was fair in both fat-to-lesion ratio (intraclass correlation coefficient score, 0.25) and elasticity score (κ = 0.28). Moderate agreement (κ = 0.46) was seen with static elastography. CONCLUSION: Elastography improves the specificity, positive predictive value, and accuracy of ultrasound. However, significant interobserver variability exists, with real-time elastographic performance showing fair agreement.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Jin Young(곽진영) ORCID logo https://orcid.org/0000-0002-6212-1495
Kim, Myung Hyun(김명현) ORCID logo https://orcid.org/0000-0002-5139-0155
Kim, Min Jung(김민정) ORCID logo https://orcid.org/0000-0003-4949-1237
Kim, Eun-Kyung(김은경) ORCID logo https://orcid.org/0000-0002-3368-5013
Moon, Hee Jung(문희정) ORCID logo https://orcid.org/0000-0002-5643-5885
Yoon, Jung Hyun(윤정현) ORCID logo https://orcid.org/0000-0002-2100-3513
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