Comb-push ultrasound shear elastography of breast masses: initial results show promise.

Max Denis,Mostafa Fatemi,Dana H Whaley,Robert T Fazzio,Pengfei Song,Azra Alizad,Sandhya Pruthi,Duane D Meixner,Mohammad Mehrmohammadi,Shigao Chen,François Hug

doi:10.1371/journal.pone.0119398

Abstract

Purpose or ObjectiveTo evaluate the performance of Comb-push Ultrasound Shear Elastography (CUSE) for classification of breast masses.Materials and MethodsCUSE is an ultrasound-based quantitative two-dimensional shear wave elasticity imaging technique, which utilizes multiple laterally distributed acoustic radiation force (ARF) beams to simultaneously excite the tissue and induce shear waves. Female patients who were categorized as having suspicious breast masses underwent CUSE evaluations prior to biopsy. An elasticity estimate within the breast mass was obtained from the CUSE shear wave speed map. Elasticity estimates of various types of benign and malignant masses were compared with biopsy results.ResultsFifty-four female patients with suspicious breast masses from our ongoing study are presented. Our cohort included 31 malignant and 23 benign breast masses. Our results indicate that the mean shear wave speed was significantly higher in malignant masses (6 ± 1.58 m/s) in comparison to benign masses (3.65 ± 1.36 m/s). Therefore, the stiffness of the mass quantified by the Young’s modulus is significantly higher in malignant masses. According to the receiver operating characteristic curve (ROC), the optimal cut-off value of 83 kPa yields 87.10% sensitivity, 82.61% specificity, and 0.88 for the area under the curve (AUC).ConclusionCUSE has the potential for clinical utility as a quantitative diagnostic imaging tool adjunct to B-mode ultrasound for differentiation of malignant and benign breast masses.

Highlights

Conventional B-mode ultrasound (US) is commonly used to differentiate benign and malignant breast masses [1,2,3,4]
Our results indicate that the mean shear wave speed was significantly higher in malignant masses (6 ± 1.58 m/s) in comparison to benign masses (3.65 ± 1.36 m/s)
B-mode US is a valuable adjunct to mammography, which improves diagnostic sensitivity, it does suffer from low specificity [5,6,7,8,9] leading to a large number of unnecessary benign biopsies [10]

Summary

Introduction

Conventional B-mode ultrasound (US) is commonly used to differentiate benign and malignant breast masses [1,2,3,4]. An additional ultrasound tool to improve specificity in the characterization and classification of breast masses would help reduce the number of unnecessary benign biopsies. Techniques that can noninvasively assess a tissue’s pathology based on its mechanical properties can improve disease diagnosis [14,15]. One such technique, quasi-static elastography, which is based on the relative deformation of the tissue or strain, has recently been reported to increase the specificity of B-mode US in differentiating between benign and malignant breast masses [14]. Because shear waves travel more slowly in softer tissue and faster in stiffer tissues, shear wave elastography could be used for characterization and classification of breast masses [17]

Methods

Results

Discussion

Conclusion