Shear wave versus strain elastography in the differentiation of benign and malignant breast lesions
Shear wave versus strain elastography in the differentiation of benign and malignant breast lesions
Background/aim: To 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 methods: The 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, maximumSWV to fat SWV ratio, and mean SWV to fat SWV ratio were measured using SWE. The strain ratio (SR) was calculated as the ratio oflesion strain to the adjacent fat strain using SE. Receiver operating characteristic (ROC) curves were constructed to assess and comparethe diagnostic performances of each parameter.Results: Forty-five benign and 42 malignant lesions were diagnosed. The sensitivity and specificity of the BIRADS classification was100% 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 tofat SWV ratio were similar to the diagnostic performance of the SR (P = 1.00, P = 1.00, P = 0.629, respectively).Conclusion: SE and SWE are both feasible imaging modalities in the differentiation of malignant and benign breast lesions with similardiagnostic performances.
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- 1. Kim YS, Park JG, Kim BS, Lee CH, Ryu DW. Diagnostic
value of elastography using acoustic radiation force impulse
imaging and strain ratio for breast tumors. Journal of Breast
Cancer 2014; 17(1): 76-82.
- 2. Ianculescu V, Ciolovan LM, Dunant A, Vielh P, Mazouni C et
al. Added value of Virtual Touch IQ shear wave elastography in
the ultrasound assessment of breast lesions. European Journal
of Radiology 2014; 83(5): 773-777.
- 3. Balçık A, Polat AV, Bayrak İK, Polat AK. Efficacy of
sonoelastography in distinguishing benign from malignant
breast masses. The Journal of Breast Health 2016; 12(1): 37-43.
- 4. Polat AV, Ozturk M, Akyuz B, Celenk C, Kefeli M et al. The
diagnostic value of shear wave elastography for parathyroid
lesions and comparison with cervical lymph nodes. Medical
Ultrasonography 2017; 19(4): 386-391.
- 5. Bekci T, Ceyhan Bilgici M, Genc G, Tekcan D, Polat AV et
al. Evaluation of renal parenchyma elasticity with acoustic
radiation force impulse quantification in nutcracker syndrome
and comparisons with grayscale doppler sonography and
laboratory findings. Journal of Ultrasound in Medicine 2017;
36(1): 61-67.
- 6. Aydin R, Elmali M, Polat AV, Danaci M, Akpolat I. Comparison
of muscle-to-nodule and parenchyma-to-nodule strain
ratios in the differentiation of benign and malignant thyroid
nodules: Which one should we use? European Journal of
Radiology 2014; 83 (3): e131-e136.
- 7. Garra BS. Imaging and estimation of tissue elasticity by
ultrasound. Ultrasound Quarterly. 2007; 23(4): 255-268.
- 8. Tozaki M, Isobe S, Sakamoto M. Combination of elastography
and tissue quantification using the acoustic radiation force
impulse (ARFI) technology for differential diagnosis of breast
masses. Japanese Journal of Radiology 2012; 30(8): 659-670.
- 9. Burnside ES, Hall TJ, Sommer AM, Hesley GK, Sisney GA et
al. Differentiating benign from malignant solid breast masses
with US strain imaging. Radiology 2007; 245(2): 401-410.
- 10. Chang JM, Moon WK, Cho N, Kim SJ. Breast mass
evaluation: factors influencing the quality of US
elastography. Radiology 2011; 259(1): 59-64.
- 11. Xue Y, Yao S, Li X, Zhang H. Value of shear wave elastography
in discriminating malignant and benign breast lesions: A meta
analysis. Medicine 2017; 96(42): e7412
- 12. Seo M, Ahn HS, Park SH, Lee JB, Choi BI et al. Comparison
and combination of strain and shear wave elastography of
breast masses for differentiation of benign and malignant
lesions by quantitative assessment: preliminary study. Journal
of Ultrasound in Medicine 2018; 37(1): 99-109.
- 13. Chang JM, Won JK, Lee KB, Park IA, Yi A et al. Comparison
of shear-wave and strain ultrasound elastography in the
differentiation of benign and malignant breast lesions. AJR
American Journal of Roentgenology 2013; 201(2):
W347-W356.
- 14. Barr RG, Zhang, Z. Shear-wave elastography of the breast:
value of a quality measure and comparison with strain
elastography. Radiology 2014; 275(1): 45-53.
- 15. Youk JH, Son EJ, Gweon HM, Kim H, Park YJ et al. Comparison
of strain and shear wave elastography for the differentiation
of benign from malignant breast lesions, combined with
B-mode ultrasonography: qualitative and quantitative
assessments. Ultrasound in Medicine & Biology 2014; 40(10):
2336-2344.
- 16. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis, CA, Glasziou
PP et al. STARD 2015: an updated list of essential items for
reporting diagnostic accuracy studies. Radiology 2015; 277(3):
826-832.
- 17. Sickles EA, D’Orsi CJ, Bassett LW et al. ACR BI-RADS
Mammography. In: D’Orsi CJ, Sickles EA, Mendelson EB,
Morris EA et al. (editors) ACR BI-RADS Atlas, Breast Imaging
Reporting and Data System. Reston, VA, USA: American
College of Radiology, 2013; pp. 134-136.
- 18. Burnside ES, Hall TJ, Sommer AM, Hesley, GK, Sisney GA et
al. Differentiating benign from malignant solid breast masses
with US strain imaging. Radiology 2007; 245(2): 401-410.
- 19. Cosgrove DO, Berg WA, Doré CJ, Skyba, DM, Henry JP
et al. Shear wave elastography for breast masses is highly
reproducible. European Radiology 2012; 22(5): 1023-1032.
- 20. Thomas A, Degenhardt F, Farrokh A, Wojcinski S, Slowinski
T et al. Significant differentiation of focal breast lesions:
calculation of strain ratio in breast sonoelastography. Academic
Radiology 2010; 17(5): 558-563.
- 21. Zhi H, Xiao XY, Yang HY, Ou B, Wen YL et al. Ultrasonic
elastography in breast cancer diagnosis: strain ratio vs 5-point
scale. Academic Radiology 2010; 17(10): 1227-1233.
- 22. Zhao QL, Ruan LT, Zhang H, Yin YM, Duan SX. Diagnosis of
solid breast lesions by elastography 5-point score and strain
ratio method. European Journal of Radiology 2012; 81(11):
3245-3249.
- 23. Tang L, Xu HX, Bo XW, Liu BJ, Li XL et al. A novel
two-dimensional quantitative shear wave elastography
for differentiating malignant from benign breast
lesions. International Journal of Clinical and Experimental
Medicine 2015; 8(7): 10920-10928.
- 24. Golatta M, Schweitzer-Martin M, Harcos A, Schott S,
Gomez C et al. Evaluation of virtual touch tissue imaging
quantification, a new shear wave velocity imaging method,
for breast lesion assessment by ultrasound. BioMed Research
International 2014; 2014: 960262.
- 25. Tozaki M, Saito M, Benson J, Fan L, Isobe S. Shear wave velocity
measurements for differential diagnosis of solid breast masses:
a comparison between virtual touch quantification and virtual
touch IQ. Ultrasound in Medicine & Biology 2013; 39(12):
2233-2245.
- 26. Magalhães M, Belo-Oliveira P, Casalta-Lopes J, Costa Y,
Gonçalo M et al. Diagnostic value of ARFI (Acoustic Radiation
Force Impulse) in differentiating benign from malignant breast
lesions. Academic Radiology 2017; 24(1): 45-52.
- 27. Kapetas P, Pinker-Domenig K, Woitek R, Clauser P, Bernathova
M et al. Clinical application of acoustic radiation force impulse
imaging with virtual touch IQ in breast ultrasound: diagnostic
performance and reproducibility of a new technique. Acta
Radiologica 2017; 58(2): 140-147.
- 28. Li XL, Xu HX, Bo XW, Liu BJ, Huang X et al. Value of
virtual touch tissue imaging quantification for evaluation of
ultrasound breast imaging-reporting and data system Category
4 lesions. Ultrasound in Medicine & Biology 2016; 42(9): 2050-
2057.
- 29. Li DD, Xu HX, Guo LH, Bo XW, Li XL et al. Combination of
two-dimensional shear wave elastography with ultrasound
breast imaging reporting and data system in the diagnosis
of breast lesions: a new method to increase the diagnostic
performance. European Radiology 2016; 26(9): 3290-3300