Shear wave versus strain elastography in the differentiation of benign and malignant breast lesions

Aykut GÜRÜF,İlkay Koray BAYRAK,Ahmet Veysel POLAT,Mesut ÖZTÜRK

doi:10.3906/sag-1905-15

Abstract

Background/aimTo evaluate and compare the diagnostic performances of shear wave elastography (SWE) and strain elastography (SE) in the differentiation of benign and malignant breast lesions.Materials and methodsThe current study included 87 breast lesions in 84 patients. The Breast Imaging Reporting and Data System (BIRADS) categories were determined with ultrasound features. The maximum shear wave velocity (SWV), mean SWV, maximum SWV to fat SWV ratio, and mean SWV to fat SWV ratio were measured using SWE. The strain ratio (SR) was calculated as the ratio of lesion strain to the adjacent fat strain using SE. Receiver operating characteristic (ROC) curves were constructed to assess and compare the diagnostic performances of each parameter.ResultsForty-five benign and 42 malignant lesions were diagnosed. The sensitivity and specificity of the BIRADS classification was 100% and 35.6%, respectively. Selecting a cutoff SR value of 3.22 led to an 88.1% sensitivity and an 88.4% specificity (AUC: 0.913 [95% CI: 0.854–0.971], P < 0.001). Selecting cutoff maximum SWV value of 3.41 m/s led to an 88.1% sensitivity and an 86.7% specificity (AUC: 0.918 [95% CI: 0.858–0.978], P < 0.001). The diagnostic performance of the maximum SWV, mean SWV, and maximum SWV to fat SWV ratio were similar to the diagnostic performance of the SR (P = 1.00, P = 1.00, P = 0.629, respectively).ConclusionSE and SWE are both feasible imaging modalities in the differentiation of malignant and benign breast lesions with similar diagnostic performances.

Highlights

Ultrasound (US) is one of the most widely used imaging modalities for the early diagnosis and management of breast cancer
Selecting a cutoff strain ratio (SR) value of 3.22 led to an 88.1% sensitivity and an 88.4% specificity (AUC: 0.913 [95% CI: 0.854–0.971], P < 0.001)
Selecting cutoff maximum shear wave velocity (SWV) value of 3.41 m/s led to an 88.1% sensitivity and an 86.7% specificity (AUC: 0.918 [95% CI: 0.858–0.978], P < 0.001)

Summary

Introduction

Ultrasound (US) is one of the most widely used imaging modalities for the early diagnosis and management of breast cancer. While this method was initially used to distinguish cystic masses from solid ones, high frequency transducers, advancements in imaging technology, and the use of the American College of Radiology Breast Imaging Reporting and Data System (BIRADS) in clinical practice has helped in differentiating breast lesions. Elastography is an US-based imaging modality that evaluates the stiffness of soft tissues by measuring the degree of distortion under pressure [3,4,5,6]. Two different techniques have been described, depending on the source of mechanical compression to the examined tissue: shear wave elastography (SWE) and strain elastography (SE).

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