Application of 3D and 2D quantitative shear wave elastography (SWE) to differentiate between benign and malignant breast masses

Jie Tian,Changjun Wu,Xi Wang,Ping Xing,Qianqi Liu,Zhuowen Yang

doi:10.1038/srep41216

Abstract

As breast cancer tissues are stiffer than normal tissues, shear wave elastography (SWE) can locally quantify tissue stiffness and provide histological information. Moreover, tissue stiffness can be observed on three-dimensional (3D) colour-coded elasticity maps. Our objective was to evaluate the diagnostic performances of quantitative features in differentiating breast masses by two-dimensional (2D) and 3D SWE. Two hundred ten consecutive women with 210 breast masses were examined with B-mode ultrasound (US) and SWE. Quantitative features of 3D and 2D SWE were assessed, including elastic modulus standard deviation (ESDE) measured on SWE mode images and ESDU measured on B-mode images, as well as maximum elasticity (Emax). Adding quantitative features to B-mode US improved the diagnostic performance (p < 0.05) and reduced false-positive biopsies (p < 0.0001). The area under the receiver operating characteristic curve (AUC) of 3D SWE was similar to that of 2D SWE for ESDE (p = 0.026) and ESDU (p = 0.159) but inferior to that of 2D SWE for Emax (p = 0.002). Compared with ESDU, ESDE showed a higher AUC on 2D (p = 0.0038) and 3D SWE (p = 0.0057). Our study indicates that quantitative features of 3D and 2D SWE can significantly improve the diagnostic performance of B-mode US, especially 3D SWE ESDE, which shows considerable clinical value.

Highlights

Breast cancer is one of the chief causes of death among women worldwide[1]
The objective of our study was to analyse the diagnostic value of standard deviation (SD) measured by different methods and to evaluate the diagnostic performance of elasticity features (Emax and SD) quantified by 2D and 3D Shear wave elastography (SWE) to distinguish benign from malignant breast masses
The quantitative values were significantly higher in the malignant masses than in the benign masses on 3D and 2D SWE (p < 0.0001 for all), which was consistent with the results reported by other studies[8,27]

Summary

Introduction

Breast cancer is one of the chief causes of death among women worldwide[1]. Ultrasound (US), as an irreplaceable tool in breast imaging and an adjunct to mammography[2], is used as a first-line examination to both detect and characterize breast masses. Recent studies have demonstrated that US elastography developed in the past decade can improve the diagnostic performance of breast US, including its specificity[7,8]. Recent studies have demonstrated that strain elastography, an important adjunct to US10,11, shows notable diagnostic performance in differentiating benign and malignant breast lesions, with a sensitivity of 78–98.6% and a specificity of 51.7–98.5%12–16. Several studies have reported the diagnostic application of SWE to differentiating breast mass types[7,21,22,23]. The information on the elasticity of breast lesions is far from being exhaustively evaluated To address this issue, three-dimensional (3D) SWE has been introduced for breast US diagnosis. The measurement methods used for assessing SD values have been inconsistent in different studies[29,30]

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Conclusion