Value of Elastography in Differentiating Benign from Malignant Breast Lesions Keeping Histopathology as Gold Standard

Abstract

Background: Breast cancer is the most common cancer in females, both in developed and developing countries. Pakistan has the highest breast cancer incidence rate in Asia. Guidelines recommend screening for detecting breast cancer with mammography and ultrasonography (US). Shear-wave elastography (SWE) is a newer technique that can aid additional characterization of breast lesions. Objective: The aim of this study was to determine the diagnostic accuracy of breast ultrasound elastography in differentiating benign from malignant breast lesions using histology diagnosis as the gold standard.Materials and methods: The study was conducted at the Abbasi Shaheed Hospital and Jinnah Post Graduate Medical Centre, Karachi. All consecutive patients undergoing breast biopsy and elastography of breast lesions were enlisted; 2 x 2 tables were used to measure the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of breast ultrasound elastography for differentiation of benign from malignant breast masses.Results: A total of 155 female patients were included with a mean age of 45.41 ± 14.24 years (range 20-70 years). On histological evaluation, 115 (74.2%) lesions were malignant and 40 (25.8%) were benign. The overall average mean elastography value was 108.45 kPa ± 52.75. The mean elastography (EMean) value for benign breast lesions was 48.96 kPa ± 42.32 and 132.78 kPa ± 42.32 for malignant lesions. The difference in mean elastography values of benign and malignant breast lesions was statistically significant (48.96 kPa ± 42.32 vs 32.78 kPa ± 42.32, P <0.001). The area under the curve (AUC) was 0.952, optimal cutoff EMean value of 72 kPa and higher likelihood ratio was 9.41. A cutoff mean elastography (EMean) value of ≤ 72 kilopascal (kPa) for benign lesions had sensitivity 92.17%, specificity 90.4%, PPV 96.36%, NPV 80.0% and diagnostic accuracy 91.61%. Conclusion: Ultrasound elastography was found to have high sensitivity and specificity and diagnostic accuracy for differentiating benign from malignant breast lesions. Use of shear-wave elastography may increase malignancy detection rate by reducing the need for biopsy in benign breast lesions.

Reproducibility and Diagnostic Value of Elastography in Evaluation of Breast Masses

“…Similarly, Farooq et al, (9) found that the overall average mean elastography value was 108.45 kPa ± 52.75. The mean elastography (E Mean) value for benign breast lesions was 48.96 kPa ± 42.32 and 132.78 kPa ± 42.32 for malignant lesions.…”

“…However, Farooq et al, (9) reported that their study sample comprised of 155 women with a mean age of 45.41 ± 14.24 years (range 20-70 years).…”

Convolutional neural network based on automatic segmentation of peritumoral shear-wave elastography images for predicting breast cancer

“…American College of Radiology Breast Imaging Reporting and Data System(ACR-BIRADS) is used for the evaluation and follow-up recommendations of breast lesions detected by US. However, radiologists’ subjective classification differences may affect diagnostic performance, thereby leading to overtreatment, especially for lesions with BI-RADS 4 category ( 5 , 6 ).…”

Accuracy and reproducibility of shear wave elastography according to the size and elasticity of lesions: A phantom study

“…[ 1 – 3 ] In breast imaging, several studies have indicated that elastography can help evaluate malignant risk. [ 4 , 5 ] In addition, assessment of breast mass by stiffness has significant diagnostic value. [ 6 ]…”

“…[1][2][3] In breast imaging, several studies have indicated that elastography can help evaluate malignant risk. [4,5] In addition, assessment of breast mass by stiffness has significant diagnostic value. [6] Elastography can be classified into 2 systems according to the methods of applying strain: strain elastography and shear wave elastography (SWE).…”