Friday, March 12, 2010


I have been watching with interest the development of new technologies in the field of ultrasound for over thirty years. Mile stones I have witnessed include real-time ultrasound (as opposed to B-scanning), color Doppler, 3-D ultrasound and portable high resolution ultrasound machines. A few years ago, one of our part time instructors told me of work her husband was doing in a relatively narrow field of ultrasound called elastography. She said that her husband's research indicated that ultrasound can be used to judge the elastic properties of abnormal superficial tissues, and that the relative stiffness of these lesions can be a predictor to whether the tissue is benign or malignant. Many skin and breast cancers become very hard, fixed and stiff compared to the surrounding normal tissue. Year later, research has proven her words to be true. Many papers have been published regarding the use of elastography in the evaluation of skin lesions, and breast masses. This science has now gained a foothold in clinical use to the point where many ultrasound manufacturers are adding the hardware and software needed to allow their equipment to be used in this manner. The benefits? One obvious benefit is we now have an accurate means of evaluating suspicious breast and skin lesions to allow us to reduce the number of biopsies performed. In the past, we routinely biopsied many masses based on fuzzy parameters in the hopes of avoiding litigation for missing a malignancy. We now have more accurate means to categorize lesions based upon stiffness, which raises our confidence level in establishing benign versus malignant without resorting to invasive biopsies. I will post links to a couple of articles written last year which discusses some specific uses of elastography.

"About eight of every 10 breast biopsies turn out to be benign. Elastography can better distinguish between benign abnormalities and cancerous breast lesions and keep unnecessary needle biopsies from ever taking place, said Dr. Stamatia V. Destounis, a diagnostic radiologist at Elizabeth Wende Breast Care in Rochester, NY."

"Tuesday at the 2009 RSNA meeting Siegel unveiled results of a study that, for the first time, looked at the utility of ultrasound elastography for identifying skin cancers.

Findings suggest that high-frequency ultrasound with elastography has the potential to measure the extent and depth of skin lesions as well as reduce the number of unnecessary skin biopsies."

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