Diagnostic Accuracy of Shear Wave Elastography in Differentiation Between Benign and Malignant Solid Breast Masses Compared with Strain Elastography

Mohamed Mohamed Hefeda,Mohammed Abdallah Hablus

doi:10.11648/j.ijmi.20190702.13

Abstract

The aim of this study was to evaluate the diagnostic performance of shear wave elastography by acoustic radiation force impulse (ARFI) elastography in differentiating malignant and benign breast Lesions in comparison with strain elastography and B mode ultrasound. This was prospective study, we used the commercially available eSie touch elastography imaging. In the shear wave elastography (SWE) we had two modes, the virtual touch imaging (VTI) with interpretation with the 5 points elasticity score and virtual touch quantification (VTQ) technique with the calculation of the Shear wave velocity (SWV). The study included 142 solid breast masses, of them 75 (52.8%) were benign and 67 (47.2%) were malignant. The mean shear wave velocity differed significantly between the benign and malignant groups (2.4+1.3m/sec and 7.3+2.2m/sec respectively, P value <0.0001). the sensitivity, specificity, PPV, NPV and accuracy of strain (eSie touch) elastography score was 83.1%, 88.73%, 88.06%, 84% and 85.92% respectively, which was less than the elastography score by ARFI (92.42%, 92.11%, 91.04%, 93.33% and 92.25% respectively) and less than the VTQ (SWV) which was 94.03%, 95.95%, 95.45% and 95.04% respectively. We concluded that Both the SWE and SE elastography showed significant difference between the benign and malignant masses, and both has added value above B mode ultrasound during routine examination. Shear wave elastography had higher sensitivity and specificity than SE, and less false negative and false positive results. The quantitative SWE (SWV) had the highest diagnostic performance among the different studied techniques.

Highlights

Among Egyptian females, breast cancer is the most common cancer in all regions, with estimated incidence rate of 26.8%-38.7% of all female cancers [1]
The aim of this study was to evaluate the diagnostic performance of acoustic radiation force impulse (ARFI) elastography in differentiating malignant and benign breast Lesions in comparison with strain elastography and B mode ultrasound
The reported sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of strain elastography score was 83.1%, 88.73%, 88.06%, 84% and 85.92% respectively, which was less than the elastography score by ARFI

Summary

Introduction

Among Egyptian females, breast cancer is the most common cancer in all regions, with estimated incidence rate of 26.8%-38.7% of all female cancers [1]. 458000 women die every year because of cancer breast [2]. Successful treatment and improvement of 5 year survival depends on early detection. Mammography and ultrasound are the usual screening techniques, but mammography is not accurate in dense breasts [3] and B mode ultrasound has low specificity [4, 5]. Elastography, a relatively new technique measuring the tissue stiffness similar to clinical palpation, is presumed to increase the specificity of the ultrasound [6, 7]. Two elastography techniques used in breast imaging are strain or free hand elastography and shear wave elastography. The strain elastography measures the relative tissue displacement under compression. The strain elastography depends on external compression, making the technique operator dependent, non reproducible and with considerable interobserver variability [8, 9]

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