Comparing the Accuracy of Sonoelastographic Ultrasound with Biopsy in the Assessment of Breast Masses among Nigerian Women in the Lagos University Teaching Hospital, Lagos, Nigeria

Background: Breast cancer is the commonest cause of cancer related deaths globally, particularly in Africa where late presentation is prevalent. Early diagnosis demands the evolution of non-invasive, highly sensitive and specific screening and diagnostic investigation. This study assessed the diagnostic properties of Sonoelastography ultrasonography, in classifying breast masses compared to biopsy among women receiving care at the Lagos University Teaching hospital (LUTH), Lagos.

Methods: Using a cross-sectional, analytical study design, 100 women with breast masses were recruited consecutively as they presented to a multidisciplinary breast clinic in LUTH. They were assessed by history taking, clinical examination, and sonoelastography ultrasound was done to classify the breast masses. Breast masses were also biopsied to get a histological diagnosis. The outcomes were compared in a cross tabulation and the sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for sonoelastography USS to assess its diagnostic properties. These indicators were also calculated for the 3 parameters (Elastography score, Strain and Lesion ratio) of sonoelastography USS.

Results: The mean age of the women with breast mass was 39.4 years with a standard deviation of 13.4 years. Above half of the women were overweight (53.0%) with tertiary education (58.0%), Mean weight of breast mass was 368.7±627.6mg. Histology report and sonoelastography USS classified 46.0% and 47.0% of breast masses respectively, as malignant breast masses. The sensitivity, specificity, and accuracy of sonoelastography USS in relation to histology report was 87.0% in the study. The diagnostic performance of each parameter was good but Elastogram score was best with 69.6% sensitivity, 87.0% specificity and 79.0% accuracy.

Conclusion: This study concluded that sonoelastography is useful in characterizing breast masses as either benign or malignant which can be compared to the use of histologic diagnosis in characterizing breast masses. The Elastography score was the elastography parameter that yielded the highest diagnostic accuracy, and the lesion ratio yielded the least diagnostic accuracy. More research may be needed for better standardization of the cut-off values to be applied for the elastography parameters (Elastography score, strain ratio and lesion ratio)to improve their diagnostic performance.