Performance Of Shear Wave Elastography Research Articles

Can Shear Wave Elastography Variables Predict the Pathological Response to Neoadjuvant Chemotherapy in Patients with Invasive Breast Cancer?

This study was designed to evaluate the performance of shear wave elastography (SWE) parameters inin predicting the pathological response of invasive breast cancer to neoadjuvant chemotherapy (NAC). The prospective study recruited 25 eligible patients from August 2016 to August 2017. SWE was performed 1 d before biopsy (time point t0, elasticity E0), after the first and second, fourth cycles of anthracycline-based or anthracycline/taxane-based NAC, and compared to a pre-NAC baseline scan. Tumour stiffness was assessed by quantitative SWE velocity. SWE parameters measured included changes in bidimensional tumour size on SWE time, quantitative SWE velocity, the relative changes in them after the first and second, fourth NAC cycles were considered as the variables [Δt1, Δt2, Δt4]. The pathological response was classified according to the residual cancer burden (RCB) protocol, RCB-0 (pCR,0); RCB-I (minimal residual disease, 0-1.36); RCB-II(moderate residual disease, 1.36-3.28); and RCB-III(extensive residual disease, >3.28). The responsive group include RCB 0 and RCB-I, the unresponsive group included RCB II and RCBIII. Correlations between SWE variables and RCB scores were evaluated. The predictive diagnostic performances of SWE parameters, and the predictive RCB (predRCB) score determined by a linear regression model were compared. SWE variables were significantly different among the RCB 0/I and RCBII/III groups. The SWE variables of Δt2had significantly better diagnostic performance than other variables regarding predicting the pathological. Our results suggest that SWE can be potentially used as an early predictor of tumor therapy response during NAC for invasive breast cancer.

Shear-Wave Elastography: Could it be Helpful for the Diagnosis of Non-Mass-Like Breast Lesions?

The goal of this study was to analyze the diagnostic performance of shear wave elastography (SWE) in differentiation of benign and malignant non-mass-like (NML) breast lesions. Three hundred sixteen consecutive breast lesions in 305 patients who have been scheduled for ultrasound (US)-guided core needle biopsy or vacuum-assisted biopsy or surgical excision between January 2013 and August 2013 were initially included in this study. Finally, 63 patients with 67 lesions classified as NML lesions comprised our study population. The features of SWE and its diagnostic performance in NML lesions were analyzed. Among the 67 NML lesions, 33 were malignant and 34 were benign. The maximum elastic modulus, mean elastic modulus, minimum elastic modulus, elastic modulus ratio and stiff rim sign of the malignant lesions were all significantly higher than those of benign lesions (p < 0.05). The combination of conventional US with maximum elastic modulus and stiff rim sign got significantly higher diagnostic specificity and positive predictive value (PPV) than conventional US (p < 0.05 for both). In the benign lesions, 23 (67.6%) unnecessary biopsies could have been eliminated after the combination of conventional US and SWE. SWE could increase diagnostic specificity and positive predictive values of NML breast lesions. The combination of conventional US and SWE could reduce unnecessary benign biopsies of NML lesions.

Diagnostic Performance of Shear Wave Elastography for Predicting Esophageal Varices in Patients With Compensated Liver Cirrhosis.

The purpose of this study was to investigate the diagnostic performance of shear wave elastography (SWE) for predicting the presence of esophageal varices and high-risk esophageal varices in patients with compensated cirrhosis and to compare it with other nonspecific predictors and according to the presence of splenomegaly. Clinical data from 103 patients with compensated cirrhosis who underwent sonography, SWE, and endoscopy were collected consecutively. Liver stiffness was measured by SWE. Comparisons of the accuracy of prediction between groups were made by areas under the receiver operating characteristic curves (AUROCs), and regression analyses were performed for the multiple variables related to the presence of esophageal varices and high-risk varices. The optimal cutoff values for predicting the presence of esophageal varices and high-risk varices were 13.9 and 16.1 kPa, respectively. The AUROC of liver stiffness for prediction of esophageal varices was significantly higher than the AUROCs of platelet count, spleen diameter, and platelet count/spleen diameter ratio (P = .025; P = .001; P = .027). For predicting esophageal varices in patients without splenomegaly, the AUROC of liver stiffness was higher than that of the platelet count/spleen diameter ratio. In multivariate logistic regression analysis, liver stiffness and the platelet count/spleen diameter ratio were independent predictors of esophageal varices (P < .001; P = .038). For the presence of high-risk varices, only liver stiffness was a statistically significant independent predictor (P = .012). In patients with compensated cirrhosis, liver stiffness measured by SWE is a new effective noninvasive diagnostic tool for predicting the presence of esophageal varices. It is more accurate than the platelet count/spleen diameter ratio, especially in patients without splenomegaly. In addition, the SWE value was the only effective independent factor for predicting high-risk esophageal varices.

The diagnostic performance of shear wave elastography for malignant cervical lymph nodes: A systematic review and meta-analysis.

To evaluate the diagnostic performance of shear wave elastography for malignant cervical lymph nodes. We searched the Ovid-MEDLINE and EMBASE databases for published studies regarding the use of shear wave elastography for diagnosing malignant cervical lymph nodes. The diagnostic performance of shear wave elastography was assessed using bivariate modelling and hierarchical summary receiver operating characteristic modelling. Meta-regression analysis and subgroup analysis according to acoustic radiation force impulse imaging (ARFI) and Supersonic shear imaging (SSI) were also performed. Eight eligible studies which included a total sample size of 481 patients with 647 cervical lymph nodes, were included. Shear wave elastography showed a summary sensitivity of 81% (95% CI: 72-88%) and specificity of 85% (95% CI: 70-93%). The results of meta-regression analysis revealed that the prevalence of malignant lymph nodes was a significant factor affecting study heterogeneity (p < .01). According to the subgroup analysis, the summary estimates of the sensitivity and specificity did not differ between ARFI and SSI (p = .93). Shear wave elastography is an acceptable imaging modality for diagnosing malignant cervical lymph nodes. We believe that both ARFI and SSI may have a complementary role for diagnosing malignant cervical lymph nodes. • Shear wave elastography is acceptable modality for diagnosing malignant cervical lymph nodes. • Shear wave elastography demonstrated summary sensitivity of 81% and specificity of 85%. • ARFI and SSI have complementary roles for diagnosing malignant cervical lymph nodes.

Shear Wave Elastography in Head and Neck Lymph Node Assessment: Image Quality and Diagnostic Impact Compared with B-Mode and Doppler Ultrasonography

The aim of this study was to assess the diagnostic performance of shear wave elastography (SWE) in comparison to B-mode and Doppler ultrasonography in differentiating benign from malignant head and neck lymph nodes (HNLNs). Sixty-two HNLNs from 56 patients were prospectively examined using B-mode, Doppler and SWE. The standard of reference was histopathology or cytology and follow-up. Qualitative malignant criteria (hilum infiltration, cortical hypo-echogenicity, irregular margins, abnormal vessels) were assessed on a five-point scale. Four quantitative parameters were obtained: long axis length, short axis length, short axis/long axis ratio, resistive index and maximum shear elasticity modulus (μmax). Diagnostic performance was analyzed with special emphasis on the sub-centimeter HNLN subgroup. Thirty HNLNs were malignant (48%). μmax intra-observer reproducibility was 0.899 (0.728 in sub-centimeter subgroup). Malignant HNLNs were stiffer (μmax = 72.4 ± 59.0 kPa) compared with benign nodes (μmax = 23.3 ± 25.3 kPa) (p < 0.001). Among the quantitative criteria, μmax had the highest diagnostic accuracy (area under the curve = 0.903 ± 0.042), especially in the sub-centimeter subgroup (area under the curve = 0.929 ± 0.045; p < 0.001) in which the area under the curve was significantly higher compared with the other quantitative criteria (p < 0.05). The additional use of SWE combined with B-mode tended to improve diagnostic accuracy (p > 0.05). SWE is a promising reproducible quantitative tool with which to predict malignant HNLNs, especially sub-centimeter nodes.

Shear Wave Elastography in the Diagnosis of Thyroid Nodules with Coexistent Chronic Autoimmune Hashimoto's Thyroiditis.

To evaluate the diagnostic performance of shear wave elastography (SWE) in the differentiation of malignant and benign thyroid nodules with coexistent Hashimoto's thyroiditis (HT). Case series with chart review. Tertiary general hospital. From September 2012 to January 2014, conventional ultrasound and SWE were performed on 243 patients with 286 thyroid nodules with histologic results. The HT group consisted of 93 patients with 117 nodules. The non-HT group consisted of 140 patients with 169 nodules. In the benign and malignant nodules, there were no significant differences of the mean, minimum, or maximum SWE values between HT and non-HT groups (P = .158-.945). However, SWE values of extranodular tissue were significantly higher in the HT group (P = .000-.011). In the HT group, the maximum SWE value showed the highest area under the receiver operating characteristic curve (0.817; 95% confidence interval, .735-.900), and there were no significant differences when compared with other SWE parameters (P = .669-.848). In the multivariate analysis, hypoechogenicity (odds ratio = 9.855, P = .002), microcalcification (odds ratio = 3.977, P = .046), and maximum SWE value (odds ratio = 40.712, P < .001) were independent predictors of thyroid malignancy. SWE could be performed to obtain a differential diagnosis between malignant and benign thyroid nodules, including nodules with coexistent HT. Although all the SWE parameters within a 2-mm region of interest that was placed on the stiffest region could be applied, we suggest that the maximum value of nodules harbored within a Hashimoto's gland be used.

Can continuous scans in orthogonal planes improve diagnostic performance of shear wave elastography for breast lesions?

Static shear wave elastography (SWE) is used to detect breast lesions, but slice and plane selections result in discrepancies. To evaluate the intraobserver reproducibility of continuous SWE, and whether quantitative elasticities in orthogonal planes perform better in the differential diagnosis of breast lesions. One hundred and twenty-two breast lesions scheduled for ultrasound-guided biopsy were recruited. Continuous SWE scans were conducted in orthogonal planes separately. Quantitative elasticities and histopathology results were collected. Reproducibility in the same plane and diagnostic performance in different planes were evaluated. The maximum and mean elasticities of the hardest portion, and standard deviation of whole lesion, had high inter-class correlation coefficients (0.87 to 0.95) and large areas under receiver operation characteristic curve (0.887 to 0.899). Without loss of accuracy, sensitivities had increased in orthogonal planes compared with single plane (from 73.17% up to 82.93% at most). Mean elasticity of whole lesion and lesion-to-parenchyma ratio were significantly less reproducible and less accurate. Continuous SWE is highly reproducible for the same observer. The maximum and mean elasticities of the hardest portion and standard deviation of whole lesion are most reliable. Furthermore, the sensitivities of the three parameters are improved in orthogonal planes without loss of accuracies.

Diagnostic performance of shear wave elastography of the breast according to scanning orientation.

To evaluate the influence of the scanning orientation on diagnostic performance measured by the mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio on ultrasound-based shear wave elastography in differentiating breast cancers from benign lesions. In this study, a total of 260 breast masses from 235 consecutive patients were observed from March 2012 to November 2012. For each lesion, the mean elasticity value, maximum elasticity value, and fat-to-lesion ratio were measured along two orthogonal directions, and all values were compared with pathologic results. There were 59 malignant and 201 benign lesions. Malignant masses showed higher mean elasticity, maximum elasticity, and fat-to-lesion ratio values than benign lesions (P < .0001). The areas under the receiver operating characteristic curves were as follows: average mean elasticity on both views, 0.870; mean elasticity on the transverse view, 0.866; maximum elasticity on both views, 0.865; maximum elasticity on the transverse view, 0.864; mean elasticity on the longitudinal view, 0.849; fat-to-lesion ratio on both views, 0.849; maximum elasticity on the longitudinal view, 0.845; fat-to-lesion ratio on the transverse view, 0.841; and fat-to-lesion ratio on the longitudinal view, 0.814. Intraclass correlation coefficients for agreement between the scanning directions were as follows: mean elasticity, 0.852; maximum elasticity, 0.842; fat-to-lesion ratio, 0.746, for masses; and mean elasticity, 0.392, for anterior mammary fat. Mean elasticity, maximum elasticity, and fat-to-lesion elasticity ratio values were helpful in differentiating benign and malignant breast masses. The scanning orientation did not significantly affect the diagnostic performance of shear wave elastography for breast masses.

Diagnostic performance of shear wave elastography in the identification of malignant thyroid nodules: a meta-analysis.

This meta-analysis aimed to assess the performance of shear wave elastography (SWE) in the identification of malignant thyroid nodules. Web of Science, Scopus, PubMed, and the references of narrative reviews were searched for relevant studies with a publication date through October 2013. The methodological quality was assessed using QUADAS tools. Data synthesis was calculated using the bivariate mixed-effects regression model. Of the 131 studies identified, 15 (11.5%) were included, in which SWE, point-SWE or 2D SWE, was used to evaluate 1,867 thyroid nodules in 1,525 patients. Methodological assessment revealed study quality was moderate to high. The pooled sensitivity, specificity, and area under the summary receiver operating characteristic curve of SWE for detecting malignant thyroid nodules were 84.3% (95% confidence interval [CI], 76.9-89.7%), 88.4% (95% CI, 84.0-91.7%), and 93% (95% CI, 90-95%), respectively. As a screening tool, positive and negative predictive values were 27.7-44.7% and 98.1-99.1%, respectively, calculated with a malignance prevalence of 5-10% in thyroid nodules. A publication bias regression test revealed no significant small-study bias. SWE is a highly accurate diagnostic modality for the identification of malignant thyroid nodules, with promise for integration into routine imaging protocols for thyroid nodules. • Shear wave elastography (SWE) is a group of novel ultrasound-based technologies. • Meta-analysis was employed to assess relevant studies of SWE of thyroid nodules. • SWE had high sensitivity and specificity in identifying malignant thyroid nodules. • The high negative predictive value of SWE can reduce unnecessary biopsies.

Shear wave elastography contribution in ultrasound diagnosis management of breast lesions.

To determine the diagnosis performance of shear wave elastography in the differentiation of benign and malignant breast lesions and the factors influencing the elasticity values. To suggest an appropriate management of breast lesions using the ultrasound-elastography combination. Monocentric retrospective study of 167 breast lesions classified by conventional ultrasound as BI-RADS category 3 or higher that underwent an elastography study and histological analysis. The analysis of qualitative parameters, according to the classification established in this study, allows us to obtain a sensitivity of 91.1% and a specificity of 92.3%. These values are very close to or better than the quantitative parameters Emax and Emean. Different Emax thresholds values were established based on the long axis of the lesion and its palpable character, which appeared to be significant factors influencing elasticity. The management of breast lesions by combining ultrasound and elastography, as proposed here, allows us to keep the sensitivity of an ultrasound (96%), while doubling its specificity (86.2% versus 43.1%). With the complementary nature of their performance, the combination of conventional ultrasound and shear wave elastography can improve the management of breast lesions. The qualitative classification proposed appears to be relevant assistance in lesion characterization.

Breast Lesions: Evaluation with Shear Wave Elastography, with Special Emphasis on the “Stiff Rim” Sign

To analyze the diagnostic performance of shear wave elastography (SWE) in differentiating between benign and malignant breast lesions, with special emphasis on the value of the "stiff rim" sign, as compared with conventional ultrasonography (US). For this ethics committee-approved retrospective study, all patients provided verbal informed consent for the analysis of their imaging data. A total of 193 consecutive women (age range, 18-82 years; mean age, 46 years) with 193 breast lesions (56 malignant, 137 benign) were included. The stiff rim sign, a qualitative SWE feature, was evaluated at the display setting of less than 180 kPa and at 180 kPa. The quantitative SWE features were assessed. Sensitivity, specificity, the area under the receiver operating characteristic curve (Az), and positive and negative likelihood ratios were calculated for conventional US features, for SWE features, and for combined conventional US and SWE features. Among all qualitative and quantitative SWE features, the stiff rim sign at the display setting (<180 kPa) showed the highest Az (0.918; 95% confidence interval [CI]: 0.870, 0.953), which was comparable to that for conventional US (0.891; 95% CI: 0.838, 0.931) (P = .40). The combination of the stiff rim sign at less than 180 kPa and conventional US features, with a positive likelihood ratio of 12.23 (95% CI: 11.5, 13.0) and a negative likelihood ratio of 0.02 (95% CI: 0.003, 0.1), yielded the highest Az (0.982; 95% CI: 0.951, 0.995)-higher than those for conventional US only and for any single SWE feature alone (P < .001 for all)-and yielded higher sensitivity (98.2% [55 of 56]; 95% CI: 90.4%, 100.0%) and similar specificity (92.0% [126 of 137]; 95% CI: 86.1%, 95.9%) compared with conventional US (P < .001 and P = .58, respectively). With use of this combination, the rate of recommendation of benign lesions for interventional procedures would decrease from 56.9% (78 of 137) (on the basis of conventional US features) to 15.3% (21 of 137), and 100.0% (56 of 56) (95% CI: 93.6%, 100.0%) malignant lesions would be correctly selected for biopsy. Adding SWE features, especially the stiff rim sign at the display setting (<180 kPa), to conventional US has the potential to improve the differentiation of breast lesions.

Shear Wave Elastography for Differentiation of Benign and Malignant Thyroid Nodules

The purpose of this study was to assess the performance of shear wave elastography for identification of benign and malignant thyroid nodules using meta-analysis. PubMed, MEDLINE, Embase, the Cochrane Library, and the China National Knowledge Infrastructure were searched. Patients' clinical characteristics, sensitivity, specificity, positive predictive value, and negative predictive value were extracted. The diagnostic odds ratio and summary receiver operating characteristic curve were used to examine the accuracy of shear wave elastography. A meta-analysis was performed to evaluate the clinical utility of shear wave elastography for identification of benign and malignant thyroid nodules. The summary sensitivity and specificity for the diagnosis of malignant thyroid nodules by shear wave elastography were 0.84 (95% confidence interval [CI], 0.76-0.90) and 0.90 (95% CI, 0.87-0.92), respectively. The pooled positive likelihood ratio was 7.39 (95% CI, 4.09-13.35), and the negative likelihood ratio was 0.20 (95% CI, 0.13-0.29). The summary diagnostic odds ratio was 41.35 (95% CI, 17.38-98.41), and the summary area under the receiver operating characteristic curve was 0.92 (Q* = 0.8538). Shear wave elastography has high sensitivity and specificity in the evaluation of thyroid nodules and can potentially reduce unnecessary fine-needle aspiration biopsies.

Performance of Shear Wave Elastography for Differentiation of Benign and Malignant Solid Breast Masses

ObjectivesTo perform a meta-analysis assessing the ability of shear wave elastography (SWE) to identify malignant breast masses.MethodsPubMed, the Cochrane Library, and the ISI Web of Knowledge were searched for studies evaluating the accuracy of SWE for identifying malignant breast masses. The diagnostic accuracy of SWE was evaluated according to sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves. An analysis was also performed according to the SWE mode used: supersonic shear imaging (SSI) and the acoustic radiation force impulse (ARFI) technique. The clinical utility of SWE for identifying malignant breast masses was evaluated using analysis of Fagan plot.ResultsA total of 9 studies, including 1888 women and 2000 breast masses, were analyzed. Summary sensitivities and specificities were 0.91 (95% confidence interval [CI], 0.88–0.94) and 0.82 (95% CI, 0.75–0.87) by SSI and 0.89 (95% CI, 0.81–0.94) and 0.91 (95% CI, 0.84–0.95) by ARFI, respectively. The HSROCs for SSI and ARFI were 0.92 (95% CI, 0.90–0.94) and 0.96 (95% CI, 0.93–0.97), respectively. SSI and ARFI were both very informative, with probabilities of 83% and 91%, respectively, for correctly differentiating between benign and malignant breast masses following a “positive” measurement (over the threshold value) and probabilities of disease as low as 10% and 11%, respectively, following a “negative” measurement (below the threshold value) when the pre-test probability was 50%.ConclusionsSWE could be used as a good identification tool for the classification of breast masses.

Quantification of Dry Needling and Posture Effects on Myofascial Trigger Points Using Ultrasound Shear-Wave Elastography

ObjectivesTo determine (1) whether the shear modulus in upper trapezius muscle myofascial trigger points (MTrPs) reduces acutely after dry needling (DN), and (2) whether a change in posture from sitting to prone affects the shear modulus. DesignUltrasound images were acquired in B mode with a linear transducer oriented in the transverse plane, followed by performance of shear-wave elastography (SWE) before and after DN and while sitting and prone. SettingUniversity. ParticipantsWomen (N=7; mean age ± SD, 46±17y) with palpable MTrPs were recruited. InterventionAll participants were dry needled in the prone position using solid filament needles that were inserted and manipulated inside the MTrPs. SWE was performed before and after DN in the sitting and prone positions. Main Outcome MeasureMTrPs were evaluated by shear modulus using SWE. ResultsPalpable reductions in stiffness were noted after DN and in the prone position. These changes were apparent in the shear modulus map obtained with ultrasound SWE. With significant main effects, the shear modulus reduced from before to after DN (P<.01) and from the sitting to the prone position (P<.05). No significant interaction effect between time and posture was observed. ConclusionsThe shear modulus measured with ultrasound SWE reduced after DN and in the prone position compared with sitting, in agreement with reductions in palpable stiffness. These findings suggest that DN and posture have significant effects on the shear modulus of MTrPs, and that shear modulus measurement with ultrasound SWE may be sensitive enough to detect these effects.

Quantitative Shear Wave Elastography in the Evaluation of Metastatic Cervical Lymph Nodes

Our aim was to compare the diagnostic performance of shear wave elastography (SWE) with that of gray-scale ultrasound (US) in differentiating metastatic from benign lymph nodes in patients with head and neck malignancies. Maximum shear elasticity modulus (maxSM) was measured on SWE. The reference standard was pathologic diagnosis after surgery. We examined 67 lymph nodes (34 metastatic, 33 benign) from 15 patients (8 men and 7 women; mean age, 54.2 years). The maxSM value was significantly higher for metastatic than benign lymph nodes (41.06 ± 36.34 kPa vs. 14.22 ± 4.19 kPa, p < 0.0001) at a cutoff level of 19.44 kPa. Accuracy, sensitivity and specificity were 94, 91 and 97%, respectively, for SWE, and 91, 88 and 94%, respectively, for gray-scale US. Multiple regression analysis showed that the maxSM value (r = 0.882) and gray-scale US criteria (r = 0.837) were independent variables. SWE may be a valuable quantitative reproducible method for characterizing cervical lymph nodes.

Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses?

To evaluate which shear wave elastography (SWE) parameter proves most accurate in the differential diagnosis of solid breast masses. One hundred and fifty-six breast lesions in 139 consecutive women (mean age: 43.54 ± 9.94 years, range 21-88 years), who had been scheduled for ultrasound-guided breast biopsy, were included. Conventional ultrasound and SWE were performed in all women before biopsy procedures. Ultrasound BI-RADS final assessment and SWE parameters were recorded. Diagnostic performance of each SWE parameter was calculated and compared with those obtained when applying cut-off values of previously published data. Performance of conventional ultrasound and ultrasound combined with each parameter was also compared. Of the 156 breast masses, 120 (76.9 %) were benign and 36 (23.1 %) malignant. Maximum stiffness (Emax) with a cut-off of 82.3 kPa had the highest area under the receiver operating characteristics curve (Az) value compared with other SWE parameters, 0.860 (sensitivity 88.9 %, specificity 77.5 %, accuracy 80.1 %). Az values of conventional ultrasound combined with each SWE parameter showed lower (but not significantly) values than with conventional ultrasound alone. Maximum stiffness (82.3 kPa) provided the best diagnostic performance. However the overall diagnostic performance of ultrasound plus SWE was not significantly better than that of conventional ultrasound alone. • SWE offers new information over and above conventional breast ultrasound • Various SWE parameters were explored regarding distinction between benign and malignant lesions • An elasticity of 82.3 kPa appears optimal in differentiating solid breast masses • However, ultrasound plus SWE was not significantly better than conventional ultrasound alone.

Differentiating benign from malignant solid breast masses: value of shear wave elastography according to lesion stiffness combined with greyscale ultrasound according to BI-RADS classification

Background:The aim of this study was to assess the performance of shear wave elastography combined with BI-RADS classification of greyscale ultrasound images for benign/malignant differentiation in a large group of patients.Methods:One hundred and seventy-five consecutive patients with solid breast masses on routine ultrasonography undergoing percutaneous biopsy had the greyscale findings classified according to the American College of Radiology BI-RADS. The mean elasticity values from four shear wave images were obtained.Results:For mean elasticity vs greyscale BI-RADS, the performance results against histology were sensitivity: 95% vs 95%, specificity: 77% vs 69%, Positive Predictive Value (PPV): 88% vs 84%, Negative Predictive Value (NPV): 90% vs 91%, and accuracy: 89% vs 86% (all P>0.05). The results for the combination (positive result from either modality counted as malignant) were sensitivity 100%, specificity 61%, PPV 82%, NPV 100%, and accuracy 86%. The combination of BI-RADS greyscale and shear wave elastography yielded superior sensitivity to BI-RADS alone (P=0.03) or shear wave alone (P=0.03). The NPV was superior in combination compared with either alone (BI-RADS P=0.01 and shear wave P=0.02).Conclusion:Together, BI-RADS assessment of greyscale ultrasound images and shear wave ultrasound elastography are extremely sensitive for detection of malignancy.