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Review
. 2018 Jan;44(1):37-70.
doi: 10.1016/j.ultrasmedbio.2017.09.012. Epub 2017 Oct 26.

Ultrasound Imaging Technologies for Breast Cancer Detection and Management: A Review

Rongrong Guo 1, Guolan Lu 2, Binjie Qin 3, Baowei Fei 4
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Free PMC article
Review

Ultrasound Imaging Technologies for Breast Cancer Detection and Management: A Review

Rongrong Guo et al. Ultrasound Med Biol. 2018 Jan.
Free PMC article

Abstract

Ultrasound imaging is a commonly used modality for breast cancer detection and diagnosis. In this review, we summarize ultrasound imaging technologies and their clinical applications for the management of breast cancer patients. The technologies include ultrasound elastography, contrast-enhanced ultrasound, 3-D ultrasound, automatic breast ultrasound and computer-aided detection of breast ultrasound. We summarize the study results seen in the literature and discuss their future directions. We also provide a review of ultrasound-guided, breast biopsy and the fusion of ultrasound with other imaging modalities, especially magnetic resonance imaging (MRI). For comparison, we also discuss the diagnostic performance of mammography, MRI, positron emission tomography and computed tomography for breast cancer diagnosis at the end of this review. New ultrasound imaging techniques, ultrasound-guided biopsy and the fusion of ultrasound with other modalities provide important tools for the management of breast patients.

Keywords: Automated ultrasound; Breast cancer; Computer-aided detection; Detection and Diagnosis; Image fusion; Magnetic resonance imaging (MRI); Positron emission tomography (PET); Three-dimensional (3D) ultrasound; Ultrasound imaging; Ultrasound-guided biopsy.

Figures

Figure 1.
Elastography could help to define the biopsy location and characterize a complex lesion. The two, left Figures, i.e. the SE image (A) and B-mode USG image (B), show a hypoechoic circumscribed lesion that is predominantly elastic and displays a mosaic pattern of green and blue. This was a fibroadenoma with a Tsukuba elasticity score of 2 and an SR of 1.76. The two, right figures, i.e. SE image (A) and B-mode USG image (B) -- the lesion (arrows), and the surrounding tissue (arrowhead) were colored blue and had an elasticity score of 5. Pathology revealed an invasive ductal carcinoma. Reprinted from (Gheonea, et al. 2011).
Figure 2.
Shear-Wave Stiffness of Breast Masses. The box-and-whisker plot of the median, maximum stiffness (termed “Emax”) on shear-wave elastography (horizontal lines in bars) as the function of the histopathologic diagnosis for 1562, sonographically visible breast masses. The boxes represent the interquartile ranges (IQRs [25th–75th percentiles]), and the whiskers represent the 1.5-times IQR. Values outside whiskers are plotted as individual dots. ADH = atypical ductal hyperplasia, LCIS = lobular carcinoma in situ, DCIS = ductal carcinoma in situ. Reprinted from (Berg, et al. 2015).
Figure 3.
Shear-wave elastography in the diagnosis of symptomatic, invasive, lobular breast cancer. A 47-year-old woman who had undergone a previous left mastectomy for ductal carcinoma in situ (DCIS), presented with a new lump in her right breast. (a) Ultrasound demonstrates benign cysts. (b) A well-defined, round lesion with posterior enhancement and mildly echogenic contents was thought to represent a thick cyst on grayscale ultrasound, but (c) SWE shows increased stiffness at and around the lesion (mean elasticity of 147 kPa). Subsequent biopsy and surgery confirmed a grade 2 ILC. Reprinted from (Sim, et al. 2015).
Figure 4.
Close evaluation of the elasticity patterns of a lesion can be helpful in their characterization and helpful in biopsy planning. A: Invasive ductal carcinoma with an area (red circle) that is “soft” on the elastogram. On pathologic examination from surgical resection, the soft area was a benign fibroadenoma, and which was not distinguishable from the invasive ductal carcinoma (yellow arrow) diagnosed in a 53 -year-old patient from the B-mode image. A spicule (green arrow) of the tumor is better seen on the elastogram. B: Images from an 85 -year-old patient who presented with a bloody nipple discharge. On the B-mode image, there is a large, complex lesion. On the elastogram, it is possible to identify a hard component (yellow arrow) and a soft component (red arrow). On pathologic examination, the solid component was a papillary carcinoma and the soft area was old blood. Reprinted from (Barr 2012).
Figure 5.
Contrast US before and after contrast medium injection in a 66-year-old woman with 23–mm, ductal, infiltrative carcinoma. (a) B mode sonography. (b) In the contrast mode (SonoVue ®) with Coherence Pulse Sequencing and B mode, the tumor is strongly enhanced after injection. Vessels are located in the peripheral area of the lesion. (c) In the contrast mode with Coherence Pulse Sequencing only, the tumoral-feeding artery is visible outside of the lesion (arrows). (d) Dynamic curve of enhancement after injection. Enhancement is fast, i.e. the delay of peak enhancement = 10 s, and with a wash-out phase (total time: two min). (e) Region of interest (ROI) on the tumor to obtain enhancing curves. (f) Mammogram. Cranio-caudal view of the right breast. Reprinted from (Balleyguier, et al. 2009)
Figure 6.
Contrast-enhanced ultrasound of a 22-year-old woman with adenofibroma. (a) Color Doppler. Smooth contours, homogeneous content, and posterior enhancement are criteria for benignity. (b) Contrast US (SonoVue ®) with Coherence Pulse Sequencing as well as thin and multiple arterial vessels are visible in the center of the lesion. Global enhancement is moderate and homogeneous. These enhancement parameters are suggestive of a benign lesion. (c) Enhancement curve. Enhancement is delayed compared with that of malignant tumors (>20 s). The enhancement value is also moderate compared with that of malignant carcinoma. The wash-out phase is longer. Reprinted from (Balleyguier, et al. 2009).
Figure 7.
Comparison of conventional ultrasound and contrast-enhanced ultrasound in a 47-year-old woman with a mass pathologically verified as low-grade DCIS. (a) Conventional US: a mass of 17 × 12 mm surrounded by a hyperechoic halo. (b) MVI: the mass shows diffuse enhancement (arrow head) and its size increases to 22 × 16 mm. Large, enhancing blood vessels were not included in the measurement. (c) Photography of the histopathological specimen (hematoxylin-eosin stain, original magnification ×20): the difference in size corresponds to the extent of intraductal carcinoma. Reprinted from (Jiang, et al. 2007).
Figure 8.
(a) Automated breast volume scanning image of infiltrating ductal carcinoma. Note the heterogeneous echogenicity, spiculated border, indistinct margin, and “taller than wide” appearance. (b) Histopathology image of the same mass. Note the infiltration of ill-defined glands into the surrounding collagenous stroma. Reprinted from (Wang, et al. 2012).
Figure 9.
Automated breast volume scanner: (A) Acuson S2000 ABVS (Siemens Medical Solutions). The transducer plate (B) is positioned over the breast and an automated scan is performed in order to obtain a series of two-dimensional images. Depending on the breast size, more than three scans per breast may be required. Reprinted from (Shin, et al. 2015).
Figure 10.
(a) Automated breast volume scanner images of an invasive ductal carcinoma of the breast in a multislice view from the skin down to the thoracic wall in the coronal plane (the slices are 0.5 mm). (b) Handheld B- mode ultrasound. The typical retraction phenomenon of the mass is observed in several, consecutive coronal planes (arrowhead on the right).This indicates the conditions of the masses at different depths. Reprinted from (Chen, et al. 2013).
Figure 11.
Automatically generated breast volume scan of diffuse, multiple, invasive ductal carcinomas in a 29-year-old woman. (a) HHUS showed a diffuse, hypoechoic area in almost the entire right breast and that was misinterpreted as adenosis. (b) Three-dimensional, ABVS multiplanar images showing the same area. This lesion was extensive (the diameter was 6.5 cm), although the margin between the tumor and the surrounding, normal parenchyma could be revealed with ABVS because of the wide scanning area. Reprinted from (Wang, et al. 2012).
Figure 12.
Automatically generated breast volume scan of an 11-year-old girl with a palpable mass (intraductal papilloma) in the left breast. These showed three orthogonal planes of the anterior–posterior left breast, i.e. coronal reconstruction (left image), axial original plane (upper right image), and sagittal reconstruction (lower right image). In the coronal plane, dilated lactiferous ducts can be detected and the intraluminal echoes can be demonstrated. Reprinted from (Wang, et al. 2012).
Figure 13.
US and the RtMR-US system. (a) Electromagnetic sensors on the tip of the probe (white arrows). (b) Electromagnetic transmitter (black arrow). (c) Connection unit between the lector magnetic transmitter, sensors, and the navigation system. (d) RtMR-US examination after co-registration. Reprinted from (Pons, et al. 2014).
Figure 14.
Glandular tissue and a Cooper’s ligament are shown at the confluence of the upper quadrant of the right breast. Live US (white arrow) using the volume navigation technique using a late phase of contrast-enhanced MR (white arrowhead) are both able to image the morphology with sharp anatomical detail. Due to the smaller magnification of the MR image, a green box is electronically displayed on the MR image, showing the US scan area. Reprinted from (Fausto, et al. 2012).
Figure 15.
A 43-year-old patient with architectural distortion and a mass in the right breast. (A) Mammography shows architectural distortion (arrow) and a well-circumscribed mass (arrowhead) on the mediolateral oblique films. (B) Coronal T1-weighted, contrast-enhanced MRI. (C) Transverse images show an irregularly shaped, margined, 12-mm mass diagnosed as invasive ductal carcinoma (arrow:c-1) as well as an oval-shaped, smooth-margined, 8-mm mass that had not been identified on conventional B-mode (arrowhead:c-2). (D) RVS shows the 12-mm, irregularly shaped mass that is taller than it is wide (a), and corresponding to the MRI lesion (b–d) (arrow). The precontrast MRI image (b) used to identify lesions in the absence of T1-weighted signals before enhancement is necessarily in the image plane displayed by the RVS system. Histopathological analysis of the sonographically guided, core biopsy samples was consistent with invasive ductal carcinoma. (E) RVS shows the 8-mm, oval mass that is wider than it is tall (a), and corresponding to the MRI lesion (b–d) (arrowhead). A histopathological analysis of sonographically guided core biopsy samples indicated that this tumor was a fibroadenoma. Reprinted from (Nakano, et al. 2012).
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portable ultrasound