Translating new breast ultrasound techniques into clinical practice: evaluating their intended uses and describing other unexpected uses for them

Abstract

Several new ultrasound tools have been developed to further evaluate breast lesions detected on B-mode ultrasound. Strain elastography (SRE) was developed to assess the likelihood of malignancy of lesions based on their stiffness. This has been incorporated into the latest edition of the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) lexicon and atlas. However, no agreed cut-off stiffness values have been established to distinguish benign from malignant lesions making the translation into routine clinical practice difficult. Superb microvascular imaging (SMI) was developed to better evaluate the vascularity within sonographic lesions and assess their likelihood of malignancy. However, there is also no agreed cut-off value for vascular index (VI) to distinguish between benign and malignant lesions. MicroPure was developed to better visualize and evaluate calcifications seen on ultrasound. Its effective use in breast screening and evaluating the calcifications detected for likelihood of malignancy have not been established. This article describes the original intended uses of these applications and reviews the studies evaluating them, showing the varying success of the translation of these tools into routine clinical practice. Also described are some other uses of these tools for which they were not originally intended. This illustrates the importance of being perceptive to alternative uses of imaging tools in their translation from bench to bedside.

Keywords: Breast ultrasound; MicroPure imaging (MP); strain elastography (SRE); superb microvascular imaging (SMI).