Breast lesions correlations: Tsukuba elastography, perfusion curves in MR and pathologic anatomy 2023-2025.

Abstract

Accurate diagnosis of breast lesions requires the integration of multiple techniques: Magnetic Resonance Imaging (MRI) with perfusion, elastography (Tsukuba score), and histology (the gold standard). This triple correlation reduces errors and optimizes the selection of patients for biopsy or surgery. Dynamic contrast-enhanced MRI assesses vascularization using perfusion curves: Type I (persistent uptake) is associated with benignity; Type II (plateau) suggests intermediate risk; and Type III (washout) is highly suggestive of malignancy. Elastography (Tsukuba) classifies stiffness: Scores 1 and 2 (soft) are generally benign (100% benign at score 2). Score 3 is intermediate (54.5% malignant). Scores 4 and 5 (stiff) are highly malignant (93.3% and 90% respectively). The correlation between MRI and histology shows: Type I, 100% benign; Type III, 100% malignant. Type II is predominantly malignant (96%). The triple correlation refines the risk: Score 3 (intermediate) correlated 100% with Type II curves, reinforcing its high risk. Score 4 (stiff) was 100% malignant. However, significant discrepancies were observed in specific entities: Soft lesions (BGR SIGN, scores 1-2) were found to be malignant (papillary and mucinous carcinomas) in up to 66.6%. Mucinous carcinoma exhibited a Type I (benign) perfusion curve in 50% of the BGR SIGN cases. These findings confirm that integrating Tsukuba and perfusion curves improves risk stratification. Nevertheless, the discrepancies in tumors like mucinous carcinoma underscore the unavoidable need for histological correlation and a multimodal approach to ensure safe clinical decisions.