Diagnostic utility of strain and shear wave ultrasound elastography in differentiation of benign and malignant solid breast lesions

Abstract

Background The purpose of our study was to assess diagnostic performance and comparison of strain and shear wave ultrasound elastography for differentiation of benign and malignant breast lesions compared to histopathological diagnosis as a reference standard. Our single center study involved 100 female patients with 132 solid breast masses. All patients underwent supervision of medical history, clinical examination, conventional B-mode ultrasound which was evaluated according to the BIRADS (Breast Imaging Reporting and Data System), and strain and shear wave ultrasound elastography. Strain ratio for strain elastography, mean elasticity value, and stiff ratio for shear wave elastography were calculated. All breast lesions were biopsied. Comparison of the elastography results with the histopathological diagnoses was done. Results There was no statistically significant difference as regard the AUCs for calculated values of strain and shear wave ultrasound elastography (strain ratio, 0.916; mean elasticity, 0.884; and stiff ratio, 0.872; P > 0.05). The AUCs for the combined use of B-mode US and elastography techniques were improved as the following: B-mode + strain, 0.920; B-mode + shear wave 0.952 with a significant P value < 0.001. Higher diagnostic accuracy was noted with the combination of strain and shear wave elastography than each single elastographic modality (P = 0.02). Conclusions Ultrasound elastography of breast masses is a non-invasive procedure with high sensitivity. Strain and shear wave elastography had almost similar diagnostic performance and displayed higher diagnostic performance if combined with B-mode ultrasound which helps in decreasing the number of unneeded breast biopsies.

Comparison of diagnostic efficacy of ultrasound, ultrasound elastography and magnetic resonance imaging for breast lesions

“…Increasing age is a recognized risk factor for breast cancer. Similar to present study, Kanagaraju et al [25] also reported mean age of patients with malignancy to be significantly higher as compared to that of benign cases. Clinical evaluation is considered to be an important part of evaluation of suspected breast lesions.…”

“…Kanumuri et al [24] , too found fibroadenoma (41%), fibrocystic disease (20.5%) and simple cyst (12.8%) as the most common benign lesions. Kanagaraju et al [25] , also made similar observations. As such fibroadenoma has been reported as the most common benign lesions in different series as seen in present study too.…”

“…A slightly lower sensitivity and specificity of MRI (88% and 80%) has been reported by ElSaid et al [20] in their study. Among different studies reviewed by us, a few studies reported specificity of MRI to be less than 80% -reporting them to be 69.7%, 50% and 57.5% respectively [23][24][25][26][27][28] but both the studies found it to be highly sensitive with sensitivity of 92.5%, 100% and 98.2% respectively.…”

“…Although, some studies conducted among suspected women have reported this incidence to be less than 30%. (24)(25)(26)(27) As such the malignancy rate in different studies might vary substantially depending upon the inclusion criteria, strength of suspected clinical features, age and level of exposure to other risk factors.…”

Comparison of Strain Elastography and Shear Wave Elastography for Differentiating Malignant From Benign Breast Masses

“…US transducer compression was used for strain does not shear wave elastography. In strain elastography, skin is repetitively compressed because of which interobserver and interobserver variability is inevitable (Ahmed, 2020). False-positive results in strain elastography of benign lesions appear due to the presence of soft tissue in the vision field.…”