Combination of shear wave elastography and BI-RADS in identification of solid breast masses

Zheng, Xue; Li, Fēi; Xuan, Zhidong; Wang, Yu; Zhang, Lei

doi:10.1186/s12880-021-00702-4

Cited by 8 publications

(7 citation statements)

References 26 publications

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“…This upgraded classification may be due to lesion features such as irregular shape, different sized calcifications and posterior shadowing. The low positive predictive value and the presence of false positive cases can be compensated for by combining US BI-RADS with elastography or contrast-enhanced US (13)(14)(15)(16)(17). Furthermore, given its high accuracy, cost effectiveness, low complication rate and convenience, core needle biopsy is the most common method used for impalpable and palpable lesions (18), and most suspicious lesions undergo an initial core needle biopsy first.…”

Section: Discussionmentioning

confidence: 99%

Value of ultrasound BI‑RADS classification in preoperative evaluation of the ultrasound‑guided Mammotome‑assisted minimally invasive resection of breast masses: A retrospective analysis

Wang

Zhang

et al. 2023

Exp Ther Med

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The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classification has been used for the diagnosis of breast masses for several decades and constantly updated, but the terminology used to describe breast ultrasound findings is still evolving and a great amount of large sample data is necessary to verify and improve ultrasound BI-RADS. The objective of the present study was to explore the value of ultrasound Breast Imaging Reporting and Data System (US BI-RADS) classification in the preoperative evaluation of the US-guided Mammotome-assisted minimally invasive resection of breast masses. A total of 1,028 patients with 1,341 breast masses from a single hospital were selected for retrospective analysis. All patients underwent minimally invasive resection using a US-guided Mammotome device, and postoperative pathological examinations were performed for all samples. The preoperative US BI-RADS classification and postoperative pathological examination results were compared and analyzed. A receiver operating characteristic (ROC) curve was used to analyze the preoperative evaluation efficacy of the US BI-RADS classification in US-guided Mammotome-assisted minimally invasive breast mass resection. Among the 1,341 breast masses that underwent resection, 1,307 were benign and 34 were malignant. The specificity, sensitivity, accuracy, positive predictive value and negative predictive value of the US BI-RADS classification in the preoperative diagnosis of malignant breast masses were 83.47, 100.00, 83.89, 13.60 and 100.00%, respectively, and the area under the ROC curve was 0.917. It may be concluded that the US BI-RADS classification has a good preoperative diagnostic performance and can provide an accurate assessment prior to Mammotome-assisted minimally invasive resection. It may help surgeons to make reasonable decisions for subsequent therapy and therefore is worthy of further clinical use.

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Section: Discussionmentioning

confidence: 99%

Value of ultrasound BI‑RADS classification in preoperative evaluation of the ultrasound‑guided Mammotome‑assisted minimally invasive resection of breast masses: A retrospective analysis

Wang

Zhang

et al. 2023

Exp Ther Med

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“…As far as the overall study was concerned, there was no definite evidence to indicate which was better, SE or SWE ( 18 ). However, the role of SWE in the diagnosis, differentiation, efficacy evaluation and prediction of breast cancer was obvious ( 13 , 14 , 27 ). One study demonstrated the superior predictive value of Emax in combination with BI-RADS category 4a in breast cancer screening ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…In a multicellular study, 104 (47.1%) of 221 false-positive results were correctly diagnosed as non-breast cancer by conventional ultrasound combined with SE ( 32 ). A study on solid breast masses found that SWE plus conventional ultrasound BI-RADS was more valuable in distinguishing benign and malignant breast lesions than color doppler or SWE alone ( 27 ). In our research, 27.4%-61.9% of category 4a lesions could be avoided biopsy by the combination of SE and SWE, which might contain no more than 2 cases of breast cancer smaller than 1cm, and would have the chance to be saved in the follow-up.…”

Section: Discussionmentioning

confidence: 99%

Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world

et al. 2022

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ObjectiveThis study aimed to explore the value of strain elastography (SE) and shear wave elastography (SWE) following the World Federation of Ultrasound in Medicine and Biology (WFUMB) guidelines and recommendations in the real world in distinguishing benign and malignant breast lesions and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.MethodsThis prospective study included 274 breast lesions. The elastography score (ES) by the Tsukuba score, the strain ratio (SR) for SE, and Emax for SWE of the lesion(A) and the regions(A’) included the lesion and the margin (0.5-5 mm) surrounding the lesion were measured. The sensitivity, specificity, and AUC were calculated and compared by the cutoff values recommended by WFUMB guidelines.ResultsWhen scores of 1 to 3 were classified as probably benign by WFUMB recommendation, the ES was significantly higher in malignant lesions compared to benign lesions (p < 0.05) in all lesions. For the cohort by size >20 mm, the sensitivity was 100%, and the specificity was 45.5%. ES had the highest AUC: 0.79(95% CI 0.72-0.86) with a sensitivity of 96.2%, and a specificity of 61.8% for the cohort by size ≤20 mm. For the Emax-A’-S2.5mm, when the high stiffness would be considered with Emax above 80 kPa in SWE, the malignant lesions were diagnosed with a sensitivity of 95.8%, a specificity of 43.3% for all lesions, a sensitivity of 88.5% for lesions with size ≤20 mm, and sensitivity of 100.0% for lesions with size >20 mm. In 84 lesions of BI-RADS category 4a, if category 4a lesions with ES of 1-3 points or Emax-A’-S2.5 less than 80 kPa could be downgraded to category 3, 52 (61.9%) lesions could be no biopsy, including two malignancies. If category 4a lesions with ES of 1-3 points and Emax-A’-S2.5 less than 80kPa could be downgraded to category 3, 23 (27.4%) lesions could be no biopsy, with no malignancy.ConclusionsThe elastography score for SE and Emax-A’ for SWE after our modification were beneficial in the diagnosis of breast cancer. The combination of SWE and SE could effectively reduce the biopsy rate of BI-RADS category 4a lesions.

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“…Shear-wave elastography (SWE) is a promising elastographic technique that can provide quantitative parameters to depict tissue stiffness, increase confidence in breast lesion characterization, and provide fine intra-and inter-observer reproducibility (7)(8)(9)(10). Previous studies have shown that most malignant lesions are much stiffer than benign lesions (3,11,12).…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown that SWE has advantages in distinguishing benign tumors from malignant tumors, and these studies have indicated that SWE features, including mean elasticity and maximum elasticity (Emax), could improve the specificity of B-mode US from 43.1-61.0% to 65.7-87.7% without resulting in a loss of sensitivity (12)(13)(14)(15). However, the most valuable SWE feature and cutoff value have not yet been unified.…”

Section: Introductionmentioning

confidence: 99%

Differential diagnosis of B-mode ultrasound Breast Imaging Reporting and Data System category 3–4a lesions in conjunction with shear-wave elastography using conservative and aggressive approaches

Zhi¹,

Miao²,

You³

et al. 2022

Quant Imaging Med Surg

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Background: The high false-positive rates of US Breast Imaging Reporting and Data System (BI-RADS) category 3-4a breast lesions leads to excessive biopsies of many benign lesions, and our aim was to investigate the diagnostic performance achieved by adding a maximum elasticity (Emax) of shear-wave elastography (SWE) to ultrasound (US) to evaluate US BI-RADS category 3-4a breast lesions using conservative and aggressive approaches. We explored the capacity of using this method to avoid unnecessary biopsies without increasing the probability of missing breast cancers.Methods: A total of 123 breast lesions of 120 patients classified as BI-RADS category 3 or 4a were enrolled from January 2019 to December 2019. The US features were evaluated according to the US BI-RADS lexicon. The maximum diameter measured on the US was defined as the size of the lesion. The Emax was assessed by SWE, and the average Emax of breast lesions on two images were calculated and recorded as the final maximum Young's modulus. The diagnostic performance of the combined B-mode US and SWE approach for BI-RADS category 3-4a breast lesions was tested using a conservative approach and an aggressive approach. In the conservative approach, the lesions were downgraded with Emax of 30 kPa or less and upgraded with Emax of 160 kPa or more. In the aggressive approach, the lesions were downgraded with Emax of 80 kPa or less and upgraded with Emax of 160 kPa or more. Pathologic results were defined as the reference standard.Results: Among all 123 breast lesions, there were 60 lesions classified as BI-RADS category 3 and 63 lesions classified as BI-RADS category 4a. Compared to the B-mode US, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic (ROC) curve (AUC) of the combined B-mode US and SWE with a conservative approach

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Combination of shear wave elastography and BI-RADS in identification of solid breast masses

Cited by 8 publications

References 26 publications

Value of ultrasound BI‑RADS classification in preoperative evaluation of the ultrasound‑guided Mammotome‑assisted minimally invasive resection of breast masses: A retrospective analysis

Value of ultrasound BI‑RADS classification in preoperative evaluation of the ultrasound‑guided Mammotome‑assisted minimally invasive resection of breast masses: A retrospective analysis

Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world

Differential diagnosis of B-mode ultrasound Breast Imaging Reporting and Data System category 3–4a lesions in conjunction with shear-wave elastography using conservative and aggressive approaches

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