Objective: To compare the diagnostic performance of the fat-to-lesion strain ratio (FLR) and gland-to-lesion strain ratio (GLR) in the diagnosis of breast lesions.
Methods: This was an institutional ethics committee approved prospective study. One hundred and ninety-three breast lesions in 193 women (mean age, 46.03 ± 13.60 years, range 18-82 years) were examined with conventional and elastographic US. Both the FLR and GLR of the lesions were calculated. The elasticity scores of the lesions were also evaluated using the five-point elasticity scoring system. For diagnostic performance, the sensitivity, specificity and receiver operating characteristic (ROC) analysis were obtained.
Results: Seventy lesions were malignant and 123 were benign. Both the FLR and GLR of the lesions were significantly higher in malignant cases than in benign ones (P < 0.001 for both). The Az values for the FLR (0.847) and the elasticity score (0.829) were significantly higher than that for the GLR (0.752) (P = 0.009, P = 0.029, respectively). However, there was no significant difference in the Az value between the FLR and the elasticity score (P = 0.443).
Conclusion: The FLR yielded better diagnostic performance than GLR in breast lesions; the fatty tissue was better than glandular tissue as the reference normal tissue for calculating strain ratio in breast elastography.
Key points: FLR was higher than GLR in both malignant and benign breast lesions. Both FLR and GLR were higher in malignant than in benign breast lesions. FLR yielded better diagnostic performance than GLR in breast lesions.