Individualized-thresholding Shear Wave Elastography combined with clinical factors improves specificity in discriminating breast masses

Abstract

Purpose To investigate the diagnostic role of new metrics, defined as individualized-thresholding of Shear Wave Elastography (SWE) parameters, in association with clinical factors (such as age, mammographic density, lesion size and depth) and the BI-RADS features in differentiating benign from malignant breast lesions. Methods Of 644 consecutive patients (median age, 55 years), prospectively referred for evaluation, 659 ultrasound detected breast lesions underwent SWE measurements. Multivariable logistic regression analysis was used to estimate the probability of malignancy. The area under the curve (AUC), optimal cutoff value, and the corresponding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined. Results 265 of 659 (40.2%) masses were malignant. Using two E mean cutoffs, 69.6 kPa for large superficial lesions (size >10 mm, depth ≤5 mm) and 39.2 kPa for the rest, the overall specificity, sensitivity, PPV and NPV were 92.6%, 86.8%, 88.8% and 91.3%, respectively. Combining multiple factors, including E mean with two cutoffs, age and BI-RADS, the new ROC curve based on the malignancy probability calculation showed the highest AUC (0.954, 95% CI: 0.938–0.969). Using the optimal probability threshold of 0.514, the corresponding specificity, sensitivity, PPV and NPV were 92.9%, 89.1%, 89.4% and 92.7%, respectively. Conclusions The false-positive rate can be significantly reduced when applying two E mean cutoffs based on lesion size and depth. Moreover, the combination of age, E mean with two cutoffs and BI-RADS can further reduce the false negatives and false positives. Overall, this multifactorial analysis improves the specificity of ultrasound while maintaining a high sensitivity.

Prediction of Invasive Breast Cancer Using Mass Characteristic Frequency and Elasticity in Correlation with Prognostic Histologic Features and Immunohistochemical Biomarkers

“…Our study indicated that adding f mass to the statistical analysis improved the overall diagnostic performance. It was found in a previous study that SWS is underestimated in small lesions (Gu, et al 2020). This is partly owing to the shear wavelength being too large for accurate estimation of speed in relatively small masses.…”

Analysis of the angular influence in the spatial study of mechanical displacements in highly anisotropic media

“…Diverse techniques are used to study mechanical properties of tumors, including optical measurements, cantilevers, elastography (Fovargue et al, 2020), and pre-stressed surfaces (Staunton et al, 2016), but additional research on these and new techniques is still needed to understand the cell-microenvironment mechanical interaction. Recent literature describes the relationship between malignant lesions and anisotropy of breast cancer confirmed that malignant lesions are more anisotropic than benign (Sinkus et al, 2001;Skerl et al, 2016aSkerl et al, , 2016bGu et al, 2020;Böl et al, 2014;Soltaninezhad et al, 2020;Soleimani et al, 2020;Yang et al, 2020;Chen et al, 2018). In 2001, R. Sinkus et al observed a tendency of breast tumors to be anisotropic (Sinkus et al, 2001).…”

“…However, not all tisues respond to these geometric configurations. On the other side, the growth of tumors is usually accompanied by processes of uncontrolled cell proliferation and migration in an anisotropic manner, proportionally to their malignancy (Gu et al, 2020). The asymmetry in these tissues is described by 21 elastic constraints, complex to be derived.…”

Intraradiological pathology‐calibrated electrical impedance spectroscopy in the evaluation of excision‐required breast lesions

“…There are many advanced techniques to increase the biopsy result accuracy, such as stereotactic biopsy, 15–17 ultrasound elastography, 18,19 multiparametric magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion biopsy, 20 contrast‐enhanced MRI, 21 and high‐velocity pulse biopsy, 22 which are primarily complicated and expensive.…”

“…11 Also, a precise selection of vital neoplastic regions to take an accurate biopsy is crucial in large heteroge-nous masses, which could directly affect the pathological evaluations. 2,[12][13][14] There are many advanced techniques to increase the biopsy result accuracy, such as stereotactic biopsy, [15][16][17] ultrasound elastography, 18,19 multiparametric magnetic resonance imaging/transrectal ultrasound (MRI/TRUS) fusion biopsy, 20 contrast-enhanced MRI, 21 and highvelocity pulse biopsy, 22 which are primarily complicated and expensive.…”