Diagnostic utility of strain and shear wave ultrasound elastography in differentiation of benign and malignant solid breast lesions

Ahmed Tohamy Ahmed

doi:10.1186/s43055-020-00181-7

Abstract

BackgroundThe purpose of our study was to assess diagnostic performance and comparison of strain and shear wave ultrasound elastography for differentiation of benign and malignant breast lesions compared to histopathological diagnosis as a reference standard. Our single center study involved 100 female patients with 132 solid breast masses. All patients underwent supervision of medical history, clinical examination, conventional B-mode ultrasound which was evaluated according to the BIRADS (Breast Imaging Reporting and Data System), and strain and shear wave ultrasound elastography. Strain ratio for strain elastography, mean elasticity value, and stiff ratio for shear wave elastography were calculated. All breast lesions were biopsied. Comparison of the elastography results with the histopathological diagnoses was done.ResultsThere was no statistically significant difference as regard the AUCs for calculated values of strain and shear wave ultrasound elastography (strain ratio, 0.916; mean elasticity, 0.884; and stiff ratio, 0.872; P > 0.05). The AUCs for the combined use of B-mode US and elastography techniques were improved as the following: B-mode + strain, 0.920; B-mode + shear wave 0.952 with a significant P value < 0.001. Higher diagnostic accuracy was noted with the combination of strain and shear wave elastography than each single elastographic modality (P = 0.02).ConclusionsUltrasound elastography of breast masses is a non-invasive procedure with high sensitivity. Strain and shear wave elastography had almost similar diagnostic performance and displayed higher diagnostic performance if combined with B-mode ultrasound which helps in decreasing the number of unneeded breast biopsies.

Highlights

The purpose of our study was to assess diagnostic performance and comparison of strain and shear wave ultrasound elastography for differentiation of benign and malignant breast lesions compared to histopathological diagnosis as a reference standard
All patients were subjected to revision of their medical history, clinical breast examination, conventional Bmode breast ultrasonography scan with categorization of masses according to Breast Imaging Reporting and Data System (BIRADS) categories, and combined strain and shear wave ultrasound elastography
Results of conventional B-mode US, strain ratio, stiff ratio, and mean elasticity value were compared with the results of histopathological diagnosis

Summary

Introduction

The purpose of our study was to assess diagnostic performance and comparison of strain and shear wave ultrasound elastography for differentiation of benign and malignant breast lesions compared to histopathological diagnosis as a reference standard. All patients underwent supervision of medical history, clinical examination, conventional Bmode ultrasound which was evaluated according to the BIRADS (Breast Imaging Reporting and Data System), and strain and shear wave ultrasound elastography. Strain ratio for strain elastography, mean elasticity value, and stiff ratio for shear wave elastography were calculated. Over the past two decades, many non-invasive imaging techniques are emerged and developed to examine the soft tissue elasticity (stiffness). The resultant deformation can be used to obtain qualitative and quantitative measurements for tissue elasticity [1]. Strain elastography assesses the relative strain between a lesion and the encompassing tissue. The pseudo-quantitative strategies like the strain ratio (the ratio of the lesion stiffness to fat), and the quantitative relation or ratio of the length of the lesion on elastography to its length on B-mode imaging have been employed in routine clinical settings owing to practicability and feasibility through real-time US, albeit true quantitative stiffness imaging has been obtainable [4, 5]

Objectives

Methods

Results

Discussion

Conclusion