Ultrasound gives today more informations both in morphology (through speed of sound optimisation and 3D acquisition) and in mechanical properties evaluations (it gives mean, maximum and minimum stiffness as well standard deviation in the ROI). Furthermore it's possible to draw freehand ROI, very useful to differentiate the tumor and the stiff surrounding stroma also in the C plane with 3D SWE. Here some clinical cases are presented.

1. Antonio Pio Masciotra
Campobasso – Molise – Italy
Email
antoniomasciotra@yahoo.it
Website
www.masciotra.net
YouTube Channel
https://www.youtube.com/channel/UCgCj21nKGAhR997Ia3-QegQ
Breast cancer clinical cases and Shear Wave Elastography

2. Woman 35 years old
Feature (kPa) Nodule
Mean stiffness 21-35
Maximum stiffness 77-199
Minimum stiffness 0,1-0,2
Standard Deviation 18-38

3. Woman 55 years old
2010 2011 2012 2013 2014

4. Woman 55 years old
Feature (kPa) Nodule
Mean stiffness 72-237
Maximum stiffness 99-199
Minimum stiffness 5-139
Standard Deviation 16-39

5. Woman 43 years old

6. Woman 44 years old

8. Woman 43 years old

9. Woman 43 years old
Feature (kPa) Right Nodule Left Nodule
Mean stiffness 6 79-180
Maximum stiffness 21 58-223
Minimum stiffness 0 35-139
Standard Deviation 1-5 18-22

10. Woman 65 years old

11. Woman 65 years old
Feature (kPa) Nodule Ax. Nod.
Mean stiffness 10-196 29-36
Maximum stiffness 38-300 65-70
Minimum stiffness 2-139 0-4
Standard Deviation 5-90 12-17

12. Woman 85 years old with very
dense breasts and retroareolar
IDC in May 2013.
Then the treatment
with Exemestane was started.
Initial and 10 months later
follow up exams are showed.
Feature (kPa) Exam
1
Exam
2
Mean stiffness 101 67
Maximum stiffness 130 74
Minimum stiffness 66 60
Standard Deviation 14 4

13. Woman 65 years old
Operated of left breast fibroadenoma in 2000
2 mammographies of left breast in comparison
(March 2012 and April 2014) and US with SWE
in April 2014
Feature (kPa) Nodule Fat
Mean stiffness 25,8 50,2
Maximum stiffness 33,1 64,7
Minimum stiffness 21,2 38,7
Standard Deviation 2,6 6,5

14. Woman 45 years old.
She felt 1 months before a lump in her left
breast becoming very painful in the last week.

15. Woman 45 years old
She felt 1 months before a lump in her left
breast becoming very painful in the last week.

16. Woman 79 years old

17. Woman 79 years old
Feature (kPa) Nodule
Mean stiffness 42-201
Maximum stiffness 67-300
Minimum stiffness 1-81
Standard Deviation 8-77

18. Woman 65 years old

19. Feature (kPa) Nodule
Mean stiffness 21-196
Maximum stiffness 47-295
Minimum stiffness 12-139
Standard Deviation 5-62
Woman 65 years old

20. 2008 2013 2014
Woman 78 years old with very dense breasts

21. Woman 78 years old with very dense breasts

22. Woman 78 years old with very dense breasts.
Actually she feels a little nodule in right upper outer quadrant.
Feature (kPa) Right breast Left breast
Mean FG stiffness 42 40
Maximum FG stiffness 47 47
Minimum FG stiffness 37 31
FG Standard Deviation 3 2

23. Woman 78 years old with very dense breasts
Feature (kPa) Probe 10-2 Probe 15-4 Probe 16-5
Mean stiffness 25-33 22-116 16-77
Maximum stiffness 30-43 30-137 38-94
Minimum stiffness 18-28 11-85 0-37
Standard Deviation 3-4 5-18 7-13

24. Woman 48 years old feeling a little pain
in upper quadrants of her right breast.
Only mammography performed at the
first exam.
9 months later she feels a nodule
between the upper quadrants of the
same breast.
27/08/2013
12/05/2014

25. 27/08/2013 12/05/2014 27/08/2013 12/05/2014
Only right breast images in
comparison are showed with
closeup details.
Very dense breast far to offer
well valuable signs.
Maybe the only differences
perceivable are in retromammary
fat area that in the second exam
seems to host ‘something new’
at least in CC view (arrows).
Then US exam was performed
showed in next slides.

26. Woman 48 years old

27. Woman 48 years old
Feature (kPa) Nodule
Mean stiffness 86-118
Maximum stiffness 135-299
Minimum stiffness 0,1-95
Standard Deviation 9-64
Hypoechoic area 0,42 cm²
Stiffest area 1,17 cm²
The tumor area traced
according echogenicity is far
smaller than the area traced
according the stiffness

28. Woman 48 years old
Feature Echogenicity
based data
Stiffness
based data
Perimeter 5,42 cm 6,63 cm
Area 1,52 cm² 2,45 cm²
Diameter 1 1,48 cm 2,19
Diameter 2 1,45 cm 1,88
The tumor area traced according echogenicity is large smaller than the area traced according the stiffness.

29. Woman 48 years oldPlane Feature Echogenicity
based data
Stiffness
based data
Difference
(%)
Coronal
Perimeter 5,89 cm 5,78 cm -1,87%
Area 1,47 cm² 2,06 cm² 40,1%
Axial
Perimeter 3,03 cm 6,48 cm 80,9%
Area 0,47 cm² 1,35 cm² 187,2%
Sagittal Perimeter 4,06 cm 5,39 cm 32,8%
Area 0,69 cm² 1,71 cm² 147,8%
The tumor’s dimensions traced according echogenicity are always smaller than the ones traced according the stiffness in all planes.
Breast cancer is staged by the TNM System : Tumor Size, node status, and metastasis.
Tumor Size is divided into four classes based on the maximum diameter:
T-1 is from 0 to 2 centimeters.
T-2 is from 2 to 5 cm.
T-3 is greater than 5 cm .
T-4 is a tumor of any size that has broken through (ulcerated) the skin, or is attached to the chest wall.
So it would be wise to check which is the most reliable imaging technique of measurement of the ‘T’ parameter
relating it to the more accurate prognostic significance and to the right choice in the therapeutic approach.
T1mi Tumor ≤1 mm in greatest dimension.
T1a Tumor >1 mm but ≤5 mm in greatest dimension.
T1b Tumor >5 mm but ≤10 mm in greatest dimension.
T1c Tumor >10 mm but ≤20 mm in greatest dimension.

30. Woman 41 years old

31. Woman 41 years old

32. Woman 41 years old

33. Woman 41 years old

34. Woman 41 years old

35. 2008 2010 Woman 58 years old 2011 2014

36. 2008 2010 Woman 58 years old 2011 2014

40. Woman 58 years old

44. 2012 2014 Woman 68 years old DCIS 2012 2014

45. Woman 68 years old DCIS

46. Antonio Pio Masciotra
Campobasso – Molise – Italy
Email
antoniomasciotra@yahoo.it
Website
www.masciotra.net
YouTube Channel
https://www.youtube.com/channel/UCgCj21nKGAhR997Ia3-QegQ
Breast cancer clinical case
 Woman with right breast IDC had quadrantectomy followed by radiotherapy 10 years ago, at age of 60
 Then she was well and in the following slides you can see the MLO and CC views done since 2008
uptodate

47. 2008 2009 2010 2011 2012 2014

48. 2008 2010 2012 2014

49. 2008 2010 2012 2014

50. 2012 2014

51. 2012 2014

52. Compared to the exam of 2 years ago the last
show a diffuse thickening of the skin and the
retinacula cutis associated to an overall
increase in density
2012
2012
2014
2014

53. 22/09/2014

54. 12/11/2014
22/09/2014

55. 12/11/2014

56. 12/11/2014

57. 12/11/2014