Performance of Shear Wave Elastography for Differentiation of Benign and Malignant Solid Breast Masses

Abstract

ObjectivesTo perform a meta-analysis assessing the ability of shear wave elastography (SWE) to identify malignant breast masses.MethodsPubMed, the Cochrane Library, and the ISI Web of Knowledge were searched for studies evaluating the accuracy of SWE for identifying malignant breast masses. The diagnostic accuracy of SWE was evaluated according to sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves. An analysis was also performed according to the SWE mode used: supersonic shear imaging (SSI) and the acoustic radiation force impulse (ARFI) technique. The clinical utility of SWE for identifying malignant breast masses was evaluated using analysis of Fagan plot.ResultsA total of 9 studies, including 1888 women and 2000 breast masses, were analyzed. Summary sensitivities and specificities were 0.91 (95% confidence interval [CI], 0.88–0.94) and 0.82 (95% CI, 0.75–0.87) by SSI and 0.89 (95% CI, 0.81–0.94) and 0.91 (95% CI, 0.84–0.95) by ARFI, respectively. The HSROCs for SSI and ARFI were 0.92 (95% CI, 0.90–0.94) and 0.96 (95% CI, 0.93–0.97), respectively. SSI and ARFI were both very informative, with probabilities of 83% and 91%, respectively, for correctly differentiating between benign and malignant breast masses following a “positive” measurement (over the threshold value) and probabilities of disease as low as 10% and 11%, respectively, following a “negative” measurement (below the threshold value) when the pre-test probability was 50%.ConclusionsSWE could be used as a good identification tool for the classification of breast masses.

Elastography ultrasound for breast lesions: fat-to-lesion strain ratio vs gland-to-lesion strain ratio

“…In addition to mammography, US has become a standard non-invasive diagnostic imaging method used for the detection of breast cancer, particularly in the dense breast [32][33][34]. Over the years breast US elastography has evolved as an adjunct to conventional US, becoming a valuable tool in clinical practice [35][36][37].…”

Why Are Viscosity and Nonlinearity Bound to Make an Impact in Clinical Elastographic Diagnosis?

“…However, no clear consensus has been reached as to what measure of the shear modulus should be used and what ROI is the most appropriate for the estimation of elasticity. What is clear is that malignant lesions show a larger shear modulus than benign [92,[184][185][186][187][188][189][190]. Still, several forms of misdiagnosis have been considered.…”

Combining Virtual Touch Tissue Imaging and BI-RADS May Improve Solid Breast Lesion Evaluation

“…Generally, benign lesions of the breast are harder than normal breast tissue but softer than malignant tumors [4][5][6]11]; however, there are exceptions. False-positive readings may be influenced by benign conditions that display poor elasticity such as scar tissue, hyperplasia, and fibroadenomas with a predominant fibrous component.…”