Automatic selection of representative slice from cine-loops of real-time sonoelastography for classifying solid breast masses.

This study aimed to evaluate the performance of automatic selection of representative slice from cine-loops of real-time sonoelastography for classifying benign and malignant breast masses. This retrospective study included 141 ultrasound elastographic studies (93 benign and 48 malignant masses). A novel computer-assisted system was developed for the automatic segmentation of the targeted lesion from cine-loops of real-time sonoelastography. Its hard ratio, defined as the ratio of the number of hard pixels within the tumor divided by the total number of pixels of the whole tumor, was also calculated. The targeted mass was segmented by edge-detection and region growing methods, with combined motion registration after manually defining the original seed. Signal-to-noise ratio (SNR(e)) and contrast-to-noise ratio (CNR(e)) of ultrasound elastogram were computed to obtain an optimum slice for differentiating benign and malignant lesions. The diagnostic results of automatic slice selection using maximum strain, maximum SNR(e), maximum CNR(e), maximum compression and the slices selected by radiologists were compared. Mann-Whitney U test, performance indexes and receiver operating characteristic (ROC) curves were used for statistical analysis. Performance using the maximum SNR(e) (accuracy 84.4%, sensitivity 83.3%, specificity 85.0% and A(z) value 0.90) was the best as compared with those of maximum CNR(e) (82.3%, 79.2%, 83.9% and 0.88, respectively), maximum compression (78.0%, 79.2%, 77.4% and 0.85, respectively), maximum strain (79.4%, 79.2%, 79.6% and 0.87, respectively) and radiologists' selection (77.3%, 77.1%, 77.4% and 0.80, respectively). Automatic selection of representative slice from the cine-loops of real-time sonoelastography is a practical, objective and accurate approach for classifying solid breast masses.