Assessment Of The Value Of Shear Wave Elastography For Differentiating Benign From Malignant Breast Lesions

Objective:The aim of this study was to assess the value of qualitative and quantitative shear wave elastography(SWE) for differentiating benign from malignant breast lesions.Methods:One hundred fourteen breast lesions in 81 patients(including 112 breast lesions in 79 women and two lesions in men)who underwent routine ultrasonography(US) and SWE before US-guided core needle biopsy or surgical excision were analyzed. these patients who were hospitalized in Department of General Surgery, First Affiliated Hospital of Shanxi Medical University, due to breast pain, breast mass, nipple discharge, nipple and breast skin changes and other symptoms. The routine ultrasonography features and SWE color overlay patterns, quantitative SWE parameters(mean elasticity, maximum elasticity,minimum elasticity, SD and elasticity ratio) were obtained. Pathologic results of all lesions were available. Diagnostic performances of routine US and US combined to SWE values were calculated and compared.Results:(1)Of the 114 breast masses, 30 in 27 patients were malignant and 84 in 57 patients were benign.(2)The χ2 test showed a significant difference between malignant and benign groups with regard to shape, orientation, margin, lesion boundary, echo pattern,calcifications, echogenic halo, posterior acoustic features and vascularity. The BI-RADS with the optimal cutoff between 3 and 4 showed a significant difference when comparedbenign to malignant breast lesions.(3) while the benign breast lesion size in SWE comparison with that in routine ultrasonography was not statistically significant difference, the benign breast lesion size in SWE was significant bigger than that in routine ultrasonography. The color overlay patterns with the optimal cutoff between 2and 3 showed a significant difference when compared benign to malignant breast lesions.For the SD, the maximum elasticity, the mean elasticity, the elasticity ratio, the area under the ROC curve respectively was 0.944,0.929,0.872,0.786. The optimal cutoff value for the SD, the maximum elasticity, the mean elasticity, the elasticity ratio was determined to be 10.3 kPa, 61.1 kPa,25.1kPa, and 3.56, respectively. the maximum elasticity and SD showed the highest accuracy among other quantitative SWE parameters.(5)the Diagnostic Performance of SWE combine with US is significant better than US alone for differentiating benign from malignant breast lesions.Conclusion:routine ultrasonography(US) is important in differentiating benign from malignant breast lesions. SWE color overlay patterns, the “Stiff Rim”Sign, the SD, the maximum elasticity, the mean elasticity and the elasticity ratio provide a new method for the differentiation of benign and malignant breast lesions. the maximum elasticity and SD showed the highest accuracy among other quantitative SWE parameters. SWE combined with routine ultrasonography BI-RADS can improve the diagnostic performance of differentiating benign from malignant breast lesions.