Qualitative Shear Wave Elastography Research Articles

Shear Wave Elastography in Breast Cancer: Unveiling Correlations With Histopathological Grades and Subtypes.

Objective This study explores the correlation between shear wave elastography (SWE) features and histopathological grades and subtypes in breast cancer, aiming to enhance diagnostic accuracy andpersonalized treatment strategies. Methods The study retrospectively analyzed 59 consecutive women with breast cancer who underwent breast ultrasound with SWE. SWE parameters and histopathologic information, including histological type and grade, were recorded. Qualitative and quantitative SWE findings were analyzed, and B-mode findings wereevaluated. Sociodemographic and clinical factors and B-mode findings were assessed as predictors of elastography stiffness using logistic regression analysis. Results Of the 59 participants diagnosed with breast cancer,invasive ductal carcinoma of no special type (IDC-NST) was predominantly found in 50 (84.7%) cases, followed by invasive medullary carcinoma in 5 (8.5%) cases. The majority of participants belonged to the 50-59 age group, comprising 19 (32.2%) patients. Histopathological grading revealed grade II tumors in 27 (45.8%) cases and grade III tumors in 24 (40.7%) cases. Notably, grade III tumors exhibited higher tissue stiffness compared to grade II tumors. Out of 36 stiff lesions, 30 (83.3%%) were IDC-NST while 3 (8.3%) wereinvasive medullary carcinoma. A significant association was observed between higher histopathological grade (grade III) and increased tissue stiffness (p < 0.05). Furthermore, among participants with stiff lesions, 21 (58.3%) exhibited color defectswhile 4 (23.5%) cases with soft lesions also displayed color defects Conclusion The correlation between SWE findings and histopathological grades and subtypes underscores the potential of SWE as a valuable tool for predicting tumor aggressiveness and characterizing specific subtypes.SWE enhances diagnostic accuracy and complements traditional imaging modalities, holding promise for personalized treatment strategies.

The value of quantitative and a new qualitative color pattern shear wave elastography for the differentiation of ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm.

This study aims to evaluate the diagnostic performance of quantitative shear wave elastography (SWE) and a new qualitative color pattern SWE for the differentiation of benign and malignant American College of Radiology Thyroid Imaging, Reporting, and Data System (ACR TI-RADS) 4 or 5 category thyroid nodules measuring ≤10 mm. From May 2020 to July 2022, a total of 237 patients with 270 thyroid nodules were enrolled, and conventional ultrasound and SWE examinations were performed for each patient. Each ACR TI-RADS 4 or 5 category thyroid nodule measuring ≤10 mm was evaluated by quantitative SWE and a new qualitative color pattern SWE. The diagnostic performance of quantitative SWE parameters, the new qualitative color pattern SWE, and the combination of SWE with ACR TI-RADS, respectively, for the differentiation of benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm was evaluated and compared. Among 270 thyroid nodules in 237 patients, 72 (26.67%) thyroid nodules were benign and 198 (73.33%) thyroid nodules were malignant. The qualitative color pattern SWE showed better diagnostic performance than the quantitative SWE parameters. When combining the qualitative color pattern SWE with ACR TI-RADS scores, with the optimal cutoff value of the total points ≥8, the thyroid nodules were considered malignant. The sensitivity, specificity, accuracy, and AUC were 89.90%, 56.94%, 81.11%, and 0.820 (95% CI: 0.768-0.864), respectively. Compared with using qualitative color pattern SWE alone, the combination of qualitative color pattern SWE and ACR TI-RADS had better diagnostic performance, which was significantly different (p < 0.05). The combination of qualitative SWE color patterns and ACR TI-RADS had high sensitivity and accuracy, which might be a convenient and useful method to differentiate benign and malignant ACR TI-RADS 4 or 5 category thyroid nodules measuring ≤10 mm. It would be helpful for the management of thyroid nodules and improving prognosis.

The value of microvascular Doppler ultrasound technique, qualitative or quantitative shear-wave elastography of breast lesions for predicting axillary nodal burden in patients with breast cancer.

The status of the axillary lymph node (ALN) in patients with breast cancer can critically inform clinical decision-making and prognosis. Preoperative evaluation of limited nodal burden (0-2 metastatic ALNs) and high nodal burden (≥3 metastatic ALNs) is vital for individual treatment in patients with breast cancer. Thus, this study aimed to evaluate the value of Angio-PLUS (AP; Aixplorer, SuperSonic Imagine) and the qualitative and quantitative shear-wave elastography (SWE) of breast lesions to predict limited or high axillary nodal burden and to develop a model for predicting limited or high axillary nodal burden. From March 2020 to November 2022, a total of 232 consecutive patients with breast cancer comprising 232 breast lesions were enrolled retrospectively from Yueyang Central Hospital. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and area under the receiver operating characteristic curve (AUC) of AP, qualitative SWE, quantitative SWE, and the predictive model for evaluating limited or high axillary nodal burden were compared. There was no significant difference in AP patterns between the limited nodal burden group and high nodal burden group. The best cutoff values of Emin (the minimal value of the first Q-box), Emean (the mean value of the first Q-box), Emax (the maximum value of the first Q-box), Eratio (ratio of the first Q-Box and the second Q-Box) and standard deviation for predicting limited or high nodal burden were 80.85 KPa, 133.45 KPa, 153.40 KPa, 9.95, and 19.25 KPa, respectively. The Emax had the highest AUC, and its sensitivity, specificity, PPV, NPV, accuracy, and AUC were 71.64%, 56.36%, 40.00%, 83.04%, 60.78%, and 0.640 [95% confidence interval (CI): 0.575-0.702], respectively. The sensitivity, specificity, PPV, NPV, accuracy, and AUC of seven color patterns for qualitative SWE were 71.64%, 74.55%, 53.33%, 86.62%, 73.71%, and 0.731 (95% CI: 0.669-0.787), respectively, which was significantly higher than all the other quantitative SWE parameters. ALN evaluation in ultrasound and qualitative SWE were independent risk factors for predicting limited or high nodal burden according to a binary logistics regression analysis. The AUC of the predictive model based on independent risk factors was 0.820 (95% CI: 0.765-0.867), which was significantly higher than that of the other independent risk factors. The seven color patterns in the qualitative SWE of breast lesions were valuable for predicting limited or high nodal burden for patients with breast cancer. Compared with quantitative SWE, qualitative SWE exhibited a better diagnostic performance. Breast lesions present no findings, vertical stripes, and spot patterns were important indicators for limited nodal burden. The predictive model developed in this study could be a simple, noninvasive, and convenient method for predicting limited or high nodal burden, which would be beneficial for clinical decision-making and individual treatment to improve prognosis.

Combined Use of Shear Wave Elastography, Microvascular Doppler Ultrasound Technique, and BI-RADS for the Differentiation of Benign and Malignant Breast Masses.

ObjectiveTo evaluate the value of the combined use of Breast Imaging Reporting and Data System (BI-RADS), qualitative shear wave elastography (SWE), and AngioPLUS microvascular Doppler ultrasound technique (AP) for distinguishing benign and malignant breast masses.Materials and MethodsA total of 210 pathologically confirmed breast lesions in 210 patients were reviewed using BI-RADS, qualitative SWE, and AP. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, and area under the receiver operating characteristic curve (AUC) of BI-RADS and the combination of qualitative SWE and/or AP with BI-RADS were compared, respectively.ResultsCompared with using BI-RADS alone, the use of combined qualitative SWE and/or AP with BI-RADS had higher AUC values (P < 0.001). Besides this, the combination of qualitative SWE and AP with BI-RADS had the best diagnostic performance for differentiating between benign and malignant masses. When AP and SWE were combined with BI-RADS, 49/76 benign masses were downgraded from BI-RADS category 4a into BI-RADS category 3, while no benign masses were upgraded from BI-RADS category 3 into BI-RADS category 4a. Three sub-centimeter malignant masses were downgraded from BI-RADS category 4a into BI-RADS category 3, while three malignant masses remain in BI-RADS category 3 due to a benign manifestation in both AP and qualitative SWE. Moreover, 5/6 of them were sub-centimeter masses, and 4/6 of them were intraductal carcinoma. The sensitivity, specificity, PPV, NPV, accuracy, and AUC were 91.0%, 81.1%, 69.3%, 95.1%, 84.3%, and 0.861 (95% confidence interval, 0.806–0.916; P < 0.001), respectively. Compared with BI-RADS alone, the sensitivity slightly decreased, while the specificity, PPV, NPV, and accuracy were significantly improved.ConclusionCombination of qualitative SWE and AP with BI-RADS improved the diagnostic performance in differentiating benign from malignant breast lesions, which is helpful for avoiding unnecessary biopsies. However, we should be careful about the downgrading of sub-centimeter BI-RADS 4a category lesions.

Clinical Value of Shear Wave Elastography Color Scores in Classifying Thyroid Nodules.

ObjectiveTo evaluate the clinical value of qualitative shear wave elastography (SWE) color in the differential diagnosis of benign and malignant thyroid nodules.MethodsFrom January 2017 to July 2018, 241 patients with 261 thyroid nodules, who underwent conventional ultrasonography and SWE examination before surgical resection, were enrolled. The nodules were also evaluated by histopathologic analyses. The SWE color characteristics that could differentiate malignant and benign thyroid nodules were selected and scored based on the malignancy rate. The diagnostic performances were evaluated by receiver operating characteristic (ROC) curves analysis.ResultsAmong the 261 thyroid nodules, 58 were benign, and 203 were malignant. Malignancy was associated with orange or red as the color of maximum hardness inside a nodule, green as the primary color, with a “stiff rim,” inhomogeneous internal color, and inhomogeneous color between the nodules and its surrounding areas. The SWE color scores for benign thyroid nodules were mainly 0 and 1, while 4 and 5 were for malignant thyroid nodules. The area under the ROC curve (AUC) of the SWE color score ≥3 for the diagnosis of malignant thyroid nodules was 0.828 (95% CI: 0.764, 0.891) with a sensitivity of 82.8%, a specificity of 82.8%, and an accuracy of 83.1%. Additionally, conventional ultrasound combined with SWE color scores had a higher diagnostic performance than conventional ultrasound (AUC 0.820 vs AUC 0.796, P = 0.04).ConclusionThe SWE color scores might be a convenient and effective method to assist in differentiating thyroid nodules.

Quantitative and Qualitative Approach for Shear Wave Elastography in Superficial Lymph Nodes

The diagnostic contribution of 2-D shear-wave elastography (SWE) in management of superficial lymph nodes (LNs) of any origin was evaluated in 222 patients referred for needle core biopsy. Each patient underwent conventional B-mode/Doppler ultrasound examinations (conventional ultrasound) and SWE. Quantitative SWE parameters and qualitative SWE map features were extracted. Carcinomas were found to be significantly stiffer than benign LNs (29.5 ± 32.3 kPa vs. 6.7 ± 12.3 kPa). Lymphomas exhibited intermediate stiffness (11.4 ± 5.2 kPa). Qualitative SWE analysis provided color patterns specific to histopathology (stiff rim, nodular and undetermined patterns related to malignancy and blue pattern to benignity). Adding SWE to conventional ultrasound improved the sensitivity of LN diagnosis (from 81.1% to 92.0%) but decreased its specificity (from 73.2% to 67.6%) because of the high prevalence of lymphomas compared with carcinomas. Inter-observer agreement for quantitative SWE was good (intra-class correlation coefficient = 0.82) as was inter-observer diagnostic agreement for qualitative SWE (κ = 0.65). LN location and histology type were found to influence the reported diagnostic performance of SWE.

Diagnostic Accuracy of Shear Wave Elastography as an Adjunct Tool in Detecting Axillary Lymph Nodes Metastasis

This study evaluates the diagnostic performance of shear wave elastography (SWE) in differentiating between benign and axillary lymph node (ALN) metastasis in breast carcinoma. Breast lesions and axillae of 107 patients were assessed using B-mode ultrasound and SWE. Histopathology was the diagnostic gold standard. In metastatic axillary lymph nodes, qualitative SWE using color patterns had the highest area under curve (AUC) value, followed by B-mode Ultrasound (cortical thickening >3 mm) and quantitative SWE using Emax of 15.2 kPa (AUC of 81.3%, 70.1%, and 61.2%, respectively). Qualitative SWE exhibited better diagnostic performance than the other two parameters, with sensitivity of 96.0% and specificity of 56.1%. Combination of B-mode Ultrasound (using cortical thickness of >3 mm as cut-off point) and qualitative SWE (Color patterns of 2 to 4) showed sensitivity of 71.6%, specificity of 95%, PPV of 96%, NPV of 66.7%, and accuracy of 80.4%. Qualitative SWE assessment exhibited higher accuracy compared to quantitative values. Qualitative SWE as an adjunct to B-mode ultrasound can further improve the diagnostic accuracy of metastatic ALN in breast cancer.

Qualitative Classification of Shear Wave Elastography for Differential Diagnosis Between Benign and Metastatic Axillary Lymph Nodes in Breast Cancer.

Purpose: To examine diagnostic performance of qualitative shear wave elastography (SWE) for evaluation of status of axillary lymph nodes (ALN) in comparison with conventional ultrasonograghy (US) and quantitative SWE parameters.Methods: A total of 118 patients were enrolled, who were all scheduled for breast cancer surgery and core needle biopsy. Conventional US and SWE were performed before biopsy. Based on qualitative evaluation of each ALN, the SWE images were classified into four color patterns: Color Pattern 1: homogeneous; Color Pattern 2: filling defect within lymph node (LN); Color Pattern 3: homogeneous within LN with a localized colored area at the margin; and Color Pattern 4: filling defect within LN with a localized colored area at the margin. The diagnostic performances of the three methods were compared.Results: There were 60 metastatic nodes and 61 benign nodes in the 121 ALNs. Benign ALNs were presented as Color Pattern 1 while metastatic ALNs usually were presented as Color Pattern 2 to 4 (p < 0.05). The AUC of qualitative SWE classification was 0.983, higher than that of quantitative SWE parameters and conventional US (p<0.05). The highest diagnostic performance, with AUC of 0.998, could be achieved if both conventional US and qualitative SWE were applied.Conclusion: The qualitative SWE classification of ALNs proposed in our study exhibited better diagnostic performance than quantitative SWE parameters and conventional US, especially for differentiating metastatic ALNs from benign reactive ALNs. More accurate diagnosis could be reached with this new method and unnecessary biopsy might be avoided in the meantime.

Diagnostic performance of qualitative and quantitative shear wave elastography in differentiating malignant from benign breast masses, and association with the histological prognostic factors.

To determine the diagnostic performance of qualitative and quantitative shear wave elastography (SWE) and the optimal cutoff values of the quantitative SWE parameters in differentiating malignant from benign breast masses, and to evaluate the association between the quantitative SWE parameters and histological prognostic factors. A gray scale ultrasound and SWE were prospectively performed on a total of 244 breast masses (148 benign, and 96 malignant) in 228 consecutive patients before an ultrasound-guided needle biopsy. The qualitative SWE and quantitative SWE parameters (the mean elasticity, maximum elasticity, and elasticity ratio) were measured in each mass. The diagnostic performance of SWE and the optimal cutoff values of the quantitative SWE parameters were obtained. An association analysis of the parameters and histological prognostic factors was performed. The malignant masses had a more heterogeneous pattern on the qualitative SWE than benign masses (P<0.001). The quantitative SWE parameters of the malignant masses were higher than those of the benign masses (P<0.001); the mean elasticity, maximum elasticity, and elasticity ratio of the benign masses were 19.73 kPa, 23.98 kPa, and 2.78, respectively; and the mean elasticity, maximum elasticity, and elasticity ratio of the malignant masses were 88.13 kPa, 98.48 kPa, and 10.64, respectively. The optimal cutoff value of the mean elasticity was 30 kPa, of the maximum elasticity was 36 kPa, and of the elasticity ratio was 4.5. The maximum elasticity had the highest AUC. Combining the three SWE parameters to differentiate between the malignant and benign masses increased the negative predictive value (NPV), which correctly downgraded 72.73% of BI-RADS category 4A masses to BI-RADS category 3. No statistically significant association was found between the quantitative SWE parameters and the tumor grading, tumor types, axillary lymph node statuses, or molecular subtypes of the breast cancers (P>0.05). The qualitative and quantitative SWE provided good diagnostic performance in differentiating malignant and benign masses. The maximum elasticity of the quantitative SWE parameters had the best diagnostic performance. Adding the three combined quantitative SWE parameters to the BI-RADS category 4A masses potentially downgraded them to BI-RADS category 3 and avoided unnecessary biopsies. No statistically significant association was found between the quantitative SWE parameters and the histological prognostic factors.

Diagnostic performances of shear-wave elastography and B-mode ultrasound to differentiate benign and malignant breast lesions: the emphasis on the cutoff value of qualitative and quantitative parameters

PurposeTo investigate the most effective cutoff values for shear-wave elastography (SWE) for differentiating benign and malignant breast lesions and to evaluate the diagnostic performance of quantitative and qualitative SWE in combination with B-mode ultrasound (US). Methods209 breast lesions from 200 patients were evaluated with B-mode US and SWE. Pathologic results determined by US-guided core needle biopsy or surgical excisions were used as a reference standard. Qualitative (four-color pattern) and quantitative analyses (Emean, Emax, SD, and E ratio) were performed. The cut-off values were defined using Youden's index. The diagnostic performance of B-mode US and combination of B-mode US with four-color pattern or quantitative parameters were compared. ResultsOf the 209 breast lesions, 102 were benign and 107 were malignant. All qualitative and quantitative SWE parameters had significantly higher specificity, positive predictive value (PPV), and accuracy compared to B-mode US (p < 0.001). The optimal cutoff values for the Emax, Emean, SD and E ratio were 145.7 kPa, 89.1 kPa, 11.9, and 3.84, respectively. The optimal cutoff for color pattern was between 3 and 4. Combined B-mode US and Emax had the highest improvement, from 17.65% to 98.04% for specificity and from 58.85% to 82.78% for accuracy, with a decrease in sensitivity compared with B-mode. ConclusionQuantitative and qualitative SWE combined with B-mode US improved the accuracy to differentiate benign from malignant lesions. Emax (cutoff, 145.7 kPa) appeared to be the most discriminatory parameter.

Tumor stiffness measured by quantitative and qualitative shear wave elastography of breast cancer.

To correlate clinicoradiologic and pathological features of breast cancer with quantitative and qualitative shear wave elastographic parameters. 82 breast cancers in 75 patients examined by B-mode ultrasound and shear wave elastography (SWE) were included. SWE parameters including quantitative factors [maximum elasticity (Emax), mean elasticity (Emean), elasticity ratio (Eratio) and standard deviation (SD)] and qualitative factor (color pattern) were correlated with clinicoradiologic and pathological features using univariate and multivariate linear regression analyses. Presence of symptoms and larger tumor size on ultrasound were significantly associated with higher Emax, Emean, Eratio, and SD (all p < 0.05) on univariate analysis. Older age was significantly correlated with higher Emax and Emean (p = 0.026, 0.018). Lymphovascular invasion and larger pathologic size were significantly associated with higher Emax (p = 0.036, 0.043) and SD (p < 0.001, 0.019). No immunohistochemical biomarkers were significantly correlated with SWE parameters. There was no significant correlation between color pattern and any variable. Multivariate logistic regression analysis showed that the symptom, tumor size on ultrasound and lymphovascular invasion were independent factors that influenced the SWE values. Tumor stiffness as measured by SWE and B-mode ultrasound could help predict cancer prognosis. Advances in knowledge: Clinicoradiologic factors had correlation with quantitative and qualitative SWE parameters. Using SWE parameters and B-mode ultrasound, we can predict breast cancer prognosis.

Shear wave elastography in the diagnosis of breast non-mass lesions: factors associated with false negative and false positive results

To investigate factors related to false shear wave elastography (SWE) results for breast non-mass lesions (NMLs) detected by B-mode US. This retrospective study enrolled 152 NMLs detected by B-mode US and later pathologically confirmed (79 malignant, 73 benign). All lesions underwent B-mode US and SWE. Quantitative (mean elasticity [E mean]) and qualitative (maximum stiffness colour) SWE parameters were assessed, and 'E mean > 85.1 kPa' or 'stiff colour (green to red)' determined malignancy. Final SWE results were matched to pathology results. Multivariate logistic regression analysis identified factors associated with false SWE results for diagnosis of breast NMLs. Associated calcifications (E mean: odds ratio [OR] = 7.60, P < 0.01; maximum stiffness colour: OR = 6.30, P = 0.02), in situ cancer compared to invasive cancer (maximum stiffness colour: OR = 5.29, P = 0.02), and lesion size (E mean: OR = 0.90, P < 0.01; maximum stiffness colour: OR = 0.91, P = 0.01) were significantly associated with false negative SWE results for malignant NMLs. Distance from the nipple (E mean: OR = 0.84, P = 0.03; maximum stiffness colour: OR = 0.93, P = 0.04) was significantly associated with false positive SWE results for benign NMLs. Presence of associated calcifications, absence of the invasive component, and smaller lesion size for malignant NMLs and shorter distance from the nipple for benign NMLs are factors significantly associated with false SWE results. • Calcification and size are associated with false negative SWE in malignant NMLs. • In situ cancer is associated with false negative SWE in malignant NMLs. • Distance from the nipple is associated with false positive SWE in benign NMLs. • These factors need consideration when performing SWE on breast NMLs.

A new qualitative pattern classification of shear wave elastograghy for solid breast mass evaluation

ObjectivesTo examine the efficacy of qualitative shear wave elastography (SWE) in the classification and evaluation of solid breast masses, and to compare this method with conventional ultrasonograghy (US), quantitative SWE parameters and qualitative SWE classification proposed before. MethodsFrom April 2015 to March 2016, 314 consecutive females with 325 breast masses who decided to undergo core needle biopsy and/or surgical biopsy were enrolled. Conventional US and SWE were previously performed in all enrolled subjects. Each mass was classified by two different qualitative classifications. One was established in our study, herein named the Qual1. Qual1 could classify the SWE images into five color patterns by the visual evaluations: Color pattern 1 (homogeneous pattern); Color pattern 2 (comparative homogeneous pattern); Color pattern 3 (irregularly heterogeneous pattern); Color pattern 4 (intralesional echo pattern); and Color pattern 5 (the stiff rim sign pattern). The second qualitative classification was named Qual2 here, and included a four-color overlay pattern classification (Tozaki and Fukuma, Acta Radiologica, 2011). The Breast Imaging Reporting and Data System (BI-RADS) assessment and quantitative SWE parameters were recorded. Diagnostic performances of conventional US, SWE parameters, and combinations of US and SWE parameters were compared. ResultsWith pathological results as the gold standard, of the 325 examined breast masses, 139 (42.77%) samples were malignant and 186 (57.23%) were benign. The Qual1 showed a higher Az value than the Qual2 and quantitative SWE parameters (all P<0.05). When applying Qual1=Color pattern 1 for downgrading and Qual1=Color pattern 5 for upgrading the BI-RADS categories, we obtained the highest Az value (0.951), and achieved a significantly higher specificity (86.56%, P=0.002) than that of the US (81.18%) with the same sensitivity (94.96%). ConclusionsThe qualitative classification proposed in this study may be representative of SWE parameters and has potential to be relevant assistance in breast mass diagnoses.

Shear-Wave Elastography for the Differential Diagnosis of Breast Papillary Lesions.

ObjectiveTo evaluate the diagnostic performance of shear-wave elastography (SWE) for the differential diagnosis of breast papillary lesions.MethodsThis study was an institutional review board-approved retrospective study, with a waiver of informed consent. A total of 79 breast papillary lesions in 71 consecutive women underwent ultrasound and SWE prior to biopsy. Ultrasound features and quantitative SWE parameters were recorded for each lesion. All lesions were surgically excised or excised using an ultrasound-guided vacuum-assisted method. The diagnostic performances of the quantitative SWE parameters were compared using the area under the receiver operating characteristic curve (AUC).ResultsOf the 79 lesions, six (7.6%) were malignant and 12 (15.2%) were atypical. Orientation, margin, and the final BI-RADS ultrasound assessments were significantly different for the papillary lesions (p < 0.05). All qualitative SWE parameters were significantly different (p < 0.05). The AUC values for SWE parameters of benign and atypical or malignant papillary lesions ranged from 0.707 to 0.757 (sensitivity, 44.4–94.4%; specificity, 42.6–88.5%). The maximum elasticity and the mean elasticity showed the highest AUC (0.757) to differentiate papillary lesions.ConclusionSWE provides additional information for the differential diagnosis of breast papillary lesions. Quantitative SWE features were helpful to differentiate breast papillary lesions.

Evaluation of the Effect of an Anisotropic Medium on Shear Wave Velocities of Intra-Muscular Gelatinous Inclusions

In highly anisotropic biological tissues such as muscle or tendons, calculating Young's modulus from the shear wave speed (csw) by using shear wave elastography (SWE) involves a complex transversally isotropic rheological model not yet used in common practice. To our knowledge, the effect of muscle anisotropy on csw of intra-muscular lesions has not yet been investigated. The objective of our study was to define the effect of an anisotropic medium on csw of intra-muscular gelatinous inclusions. We conducted a prospective monocentric, in vitro study in order to examine the quantitative and qualitative SWE behavior of a 9-mm gelatinous intra-muscular implant depending on the orientation of the probe relative to the muscle fibers. There were very significant differences in the prevalence of SWE signal void (p < 0.01) and in the csw (p < 0.01) in the gelatinous intra-muscular implants depending on the orientation of the probe relative to the fibers. Performing the csw measurements of centimetric intra-muscular lesions by orienting the probe perpendicular to the fibers decreases the probability of artifacts occurring at high intensity interfaces.

Do quantitative and qualitative shear wave elastography have a role in evaluating musculoskeletal soft tissue masses?

ObjectivesTo determine if quantitative and qualitative shear wave elastography have roles in evaluating musculoskeletal masses.Methods105 consecutive patients, prospectively referred for biopsy within a specialist sarcoma centre, underwent B-mode, quantitative (m/s) and qualitative (colour map) shear wave elastography. Reference was histology from subsequent biopsy or excision where possible. Statistical modelling was performed to test elastography data and/or B-mode imaging in predicting malignancy.ResultsOf 105 masses, 39 were malignant and 6 had no histology but benign characteristics at 12 months. Radiologist agreement for B-mode and elastography was moderate to excellent Kw 0.52-0.64; PABAKw 0.85-0.90). B-Mode imaging had 78.8% specificity, 76.9% sensitivity for malignancy. Quantitatively, adjusting for age, B-mode and lesion volume there was no statistically significant association between longitudinal velocity and malignancy (OR [95% CI] 0.40[0.10, 1.60], p=0.193), but some evidence that higher transverse velocity was associated with decreased odds of malignancy (0.28[0.06, 1.28], p=0.101). Qualitatively malignant masses tended to be towards the blue spectrum (lower velocities); 39.5% (17/43) of predominantly blue masses were malignant, compared to 14.3% (1/7) of red lesions.ConclusionsQuantitatively and qualitatively there is no statistically significant association between shear wave velocity and malignancy. There is no clear additional role to B-mode imaging currently.Key Points• Correlation between shear wave velocity and soft tissue malignancy was statistically insignificant• B-mode ultrasound is 76.9 % sensitive and 78.8 % specific• Statistical models show elastography does not significantly add to lesion assessment

Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ.

To investigate whether mass stiffness measured by shear-wave elastography (SWE) can predict the histological upgrade of ductal carcinoma in situ (DCIS) confirmed through ultrasound (US)-guided core needle biopsy (CNB). The institutional review board approved this study and informed consent was waived. A database search revealed 120 biopsy-confirmed DCIS in patients who underwent B-mode US and SWE prior to surgery. Clinicopathologic results, B-mode findings, size on US, and mean and maximum elasticity values on SWE were recorded. Associations between upgrade to invasive cancer and B-mode US findings, SWE information, and clinical variables were assessed using univariate, multivariate logistic regression, and multiple linear regression analysis. The overall upgrade rate was 41.7% (50/120). Mean stiffness value (P = .014) and mass size (P = .001) were significantly correlated with histological upgrade. The optimal cut-off value of mean stiffness value, yielding the maximal sum of sensitivity and specificity, was 70.7kPa showing sensitivity of 72% and specificity of 65.7% for detecting invasiveness. Qualitative elasticity colour scores were significantly correlated with the histological upgrade, mammographic density, and B-mode category (P < .04). Mean stiffness values evaluated through SWE can be utilized as a preoperative predictor of histological upgrade to invasive cancer in DCIS confirmed at US-guided needle biopsy. • Higher stiffness values were noted in invasive cancer than DCIS. • Qualitative SWE colour scores significantly correlated with the histological upgrade. • Qualitative SWE colour scores had excellent interobserver agreement.

Shear Wave Elastography (SWE): An Analysis of Breast Lesion Characterization in 83 Breast Lesions

Qualitative and quantitative shear wave elastography (SWE) criteria were assessed to differentiate between malignant and benign breast lesions. This prospective study included 83 lesions. SWE features measured included maximal stiffness values inside the lesion (Elesion) and in the peri-lesion area (Eperilesion) and ratio values (Rlesion and Rperilesion) according to the formula Elesion or Eperilesion/Efat, with Efat corresponding to normal fatty tissue. We compared ultrasonography (B-mode), SWE and histologic sizes. With qualitative and quantitative SWE analysis, sensitivity was 94% and specificity 73%. Malignant lesions appeared more heterogeneous, with higher stiffness and ratio values than benign lesions (p < 0.001). For malignant lesions, SWE size was better correlated to histologic size than B-mode size. Using benign SWE signs to selectively downgrade category 4a and 4b lesions, the specificity improved from 13% to 51% without loss in sensitivity (100%) compared to ultrasound.

Diagnostic performance and color overlay pattern in shear wave elastography (SWE) for palpable breast mass

ObjectiveThe purpose of this study is to evaluate the diagnostic performance of SWE in palpable breast mass and to compare with color overlay pattern in SWE with conventional US and quantitative SWE for assessing palpable breast mass. MethodsSWE and conventional breast US were performed in 133 women with 156 palpable breast lesions (81 benign, 75 malignant) between August 2013 to June 2014. Either pathology or periodic imaging surveillance more than 2 years was a reference standard. Existence of previous image was blinded to performing radiologists. US BI-RADS final assessment, qualitative and quantitative SWE measurements were evaluated. Diagnostic performances of grayscale US, SWE and US combined to SWE were calculated and compared. Correlation between pattern classification and quantitative SWE was evaluated. ResultsBoth color overlay pattern and quantitative SWE improved the specificity of conventional US, from 81.48% to 96.30% (p=0.0005), without improvement in sensitivity. Color overlay pattern was significantly related to all quantitative SWE parameters and malignancy rate (p<0.0001.). The optimal cutoff of color overlay pattern was between 2 and 3. Emax with optimal cutoff at 45.1kPa showed the highest Az value, sensitivity, specificity and accuracy among other quantitative SWE parameters (p<0.0001). Echogenic halo on grayscale US showed significant correlation with color overlay pattern and pathology (p<0.0001). ConclusionsIn evaluation of palpable breast mass, conventional US combine to SWE improves specificity and reduces the number of biopsies that ultimately yield a benign result. Color overlay pattern classification is more quick and easy and may represent quantitative SWE measurements with similar diagnostic performances.

Addition of shear-wave elastography during second-look MR imaging-directed breast US: effect on lesion detection and biopsy targeting.

To determine if adding shear-wave elastography (SWE) to second-look ultrasonography (US) after breast dynamic contrast material-enhanced (DCE) magnetic resonance (MR) imaging helps find or target lesions seen on DCE MR images for US-guided biopsy. This HIPAA-compliant prospective study was approved by the institutional review board, and written informed consent was obtained from patients. From May 2011 to July 2012, 73 women with 96 Breast Imaging Reporting and Data System (BI-RADS) category 4 or 5 lesions after DCE MR imaging prospectively consented to undergo SWE during second-look US. If a lesion was not confidently seen with B-mode US, SWE during real-time scanning was performed to determine if SWE helped find or target lesions for US biopsy. A qualitative SWE six-point color scale was used to record the maximum elasticity in and around lesions. All lesions underwent US or DCE MR imaging-guided core biopsy. Median participant age was 52 years (range, 21-81 years). In 72 patients who underwent DCE MR imaging, 96 BI-RADS category 4 or 5 lesions were detected in 81 breasts. There were 29 (30%) malignancies (one malignancy was of nonbreast origin), 14 (15%) high-risk lesions, and 53 (55%) benign lesions. US revealed 22 cancers, and seven cancers were detected only with MR imaging. Real-time SWE helped find one lesion and target four lesions that were incompletely assessed with gray-scale US. These five lesions that were localized or targeted for biopsy were invasive cancers, representing 23% of the 22 malignancies detected with US. Real-time SWE added to second-look US after DCE MR imaging increased the detection rate of cancers and helped target cancers for US-guided biopsy.