Confirmed value of shear wave elastography for ultrasound characterization of breast masses using a conservative approach in Chinese women: a large-size prospective multicenter trial

Abstract

PurposeThis study aimed to investigate the value of shear wave elastography (SWE) for characterization of breast masses in a Chinese population.Patients and methodsTwo thousand two hundred seventy-three women consented to be prospectively enrolled for the characterization of breast masses with ultrasound and SWE. Breast masses were known from symptoms, palpability, and/or previous imaging screening with mammography and/or ultrasound. Correlation of SWE qualitative and quantitative features with malignancy risk and impact on diagnostic performance of combining SWE features were assessed, and the Breast Imaging Reporting and Data System (BI-RADS) scoring was calculated using histopathology as reference.ResultsData of 2,262 masses (median size: 13 mm; range: 1.3–50) from 2,262 patients (median age: 43 years; range: 18–91) were investigated, of which 752 (33.3%) were malignant. Sensitivity and specificity of BI-RADS diagnosis were 97.5% (733/752) and 54.8% (827/1,510), respectively. By logistic regression, the combination of maximum elasticity (Emax) measurements with BI-RADS assessments increased the area under the receiver operating characteristic curve from 0.908 (95% CI: 0.896–0.920) to 0.954 (95% CI: 0.944–0.962). Using Emax of 30 kPa or lower to selectively downgrade BI-RADS 4a masses to follow-up, and Emax of 160 kPa or higher to selectively upgrade BI-RADS 3 lesions to biopsy, specificity significantly increased from 54.8% (827/1,510) to 66.1% (998/1,510) (P<0.001) while sensitivity decreased nonsignificantly from 97.5% (733/752) to 96.9% (729/752) (P=0.2891). Positive predictive value for biopsy recommendation increased from 51.7% (733/1,417) to 58.7% (729/1,241) (P<0.001).ConclusionAdding SWE maximum stiffness to BI-RADS 3 and BI-RADS 4a breast masses in a Chinese population increased significantly the specificity of breast ultrasonography, without significant change in sensitivity.

Value of quantitative sound touch elastography of tissues around breast lesions in the evaluation of malignancy

“…In addition, increased stiffness of surrounding tissue, such as the "stiff rim" sign, can also occur in benign lesions, 27 unlike the result in the study of. 28 The study of Xiang et al shows that hard cyclic disorders in benign lesions are associated with age and depth, internal composition, and edges of the lesions. Therefore, joint diagnosis using multiple markers is necessary.…”

Combined Use of Shear Wave Elastography, Microvascular Doppler Ultrasound Technique, and BI-RADS for the Differentiation of Benign and Malignant Breast Masses

“…As for the qualitative SWE features, we used seven color patterns in this study ( 20 ): (1) no finding: no difference is observed at the margin of or inside the lesion with the color around the lesion (homogeneously blue); (2) vertical stripes pattern: a color is observed at the margin of or inside the lesion, which differs from the color around the lesion. The differing color extends beyond the lesion and continues vertically in cords on the cutaneous side and/or the thoracic wall; (3) spots pattern: colored areas are visible above and/or below the lesion; and (4) rim of stiffness pattern: a localized colored area appears at the margin of the lesion and creates a continuous closed circle; (5) colored lesion pattern: colored areas are heterogeneously visible inside the lesion; (6) void center pattern: There is a lack of SWE signal inside the lesion.…”

Combination diagnosis with elastography strain ratio and molecular markers effectively improves the diagnosis rate of small breast cancer and lymph node metastasis

“…Conventional US (including two-dimensional gray-scale US, two-dimensional color Doppler US, and spectral Doppler US) was used to examine all solid lesions, and after comprehensive analyses, masses were classified using the Breast Imaging Reporting and Data System (BI-RADS) into the following: Class I, negative; Class II, benign; Class III, probably benign; Class IV, suspicious malignant; Class V, malignant (22). UE using a EUP L 54M scanner (50 mm, 6-13 MHz) equipped with elastography software (EUB-8500, Hitachi) was performed in the UE-mode with a pressure bar showing a digital readout [1][2][3][4][5][6][7] on the screen, which represented a comprehensive index of external and imposed external force frequencies. We selected readout 3 as the standard in our study.…”

“…Ultrasound elastography (UE) is a non-invasive imaging technique, which facilitates the measurement of tumor elasticity and the early diagnosis of malignant breast tumors (1)(2)(3). Although the use of UE has been discredited in diagnosing small nodular breast tumors, previous studies have shown that UE has the advantage of distinguishing and localizing concealed and hard-to-reach small breast lesions missed by routine ultrasound (US) examinations, especially in differentiating malignant from benign tumors (2,4).…”