Virtual touch tissue imaging quantification shear wave elastography for the differential diagnosis of breast lesions

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Objective To evaluate the diagnostic value of the novel virtual touch tissue imaging quantification (VTIQ) technique of acoustic radiation force impulse (ARFI) elastography in the differential diagnosis between benign and malignant breast lesions. Methods The imaging data of 60 pathologically proven breast masses in 60 patients at the Tenth People′s Hospital of Tongji University were retrospectively analyzed from June to July in 2014. The breast lesions were first examined by conventional ultrasound. The size, boundary, internal echogenicity, and blood supply were observed and recorded, and then the lesions were classified by Breast Imaging Reporting And Data System (BI-RADS). The average shear wave velocity (SWV) value was obtained from multiple SWV measurements under the VTIQ speed mode. BI-RADS≥4 was defined as the malignant standard and BI-RADS<4 as the benign standard for differential diagnosis. According to the pathological results, the sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index of breast masses with BI-RADS were obtained. SWV values of benign and malignant breast tumors were compared by t test. The receiver operating characteristic curve of VTIQ technique for differential diagnosis of benign and malignant breast masses was drawn. Results In 60 breast tumors, there were 18 malignant lesions (18 infiltrating ductal carcinomas) and 42 benign lesions (21 fibroadenoma, 16 adenosis, 2 adenosis with ductal dilatation, 1 intraductal papilloma, 1 benign phyllodes tumor and 1 papillary tumor). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index of BI-RADS were 88.8%, 59.5%, 68.3%, 48.5%, 92.6%, and 0.48, respectively. The average SWV value of malignant breast masses was higher than that of benign breast masses, and the difference was statistically significant [(6.35±1.59) m/s vs (2.28 ± 0.64) m/s, t=9.14, P<0.001]. The cut-off value of VTIQ SWV was 4.2 m/s according to ROC curve analysis. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and Youden index for VTIQ were 94.4%, 66.6%, 75%, 54.8%, 96.5%, and 0.61, respectively. Conclusion Compared with ultrasound BI-RADS classification, VTIQ elastography technique can significantly improves the capability in differential diagnosis of breast masses. Key words: Breast diseases; Elasticity imaging techniques; Diagnosis, differential