Breast Lesions: Quantitative Diagnosis Using Ultrasound Shear Wave Elastography—A Systematic Review and Meta-Analysis

Abstract

The aim of this meta-analysis was to estimate the diagnostic performance of shear wave elastography (SWE) in differentiating malignant from benign breast lesions. A literature search of PubMed, Web of Science and Scopus up to November 2014 was conducted. A summary receiver operating characteristic curve was constructed, and pooled weighted estimates of sensitivity and specificity were calculated using a bivariate mixed-effects regression model. Thirty-three studies, which included a total of 5838 lesions (2093 malignant, 3745 benign) from 5397 patients, were finally analyzed. Summary sensitivity and specificity were 0.886 (95% confidence interval [CI], 0.858-0.909) and 0.866 (95% CI, 0.833-0.894), respectively. The pooled diagnostic odds ratio was 50.410 (95% CI, 34.972-72.664). And the area under the receiver operating characteristic curve of SWE was 0.94 (95% CI, 0.91-0.96). No publication bias existed among these studies (p = 0.245). In the subgroup analysis, sensitivity and specificity were 0.862 (95% CI, 0.811-0.901) and 0.875 (95% CI, 0.793-0.928) among 1552 lesions from 1429 patients in the 12 studies using acoustic radiation force impulse imaging and 0.897 (95% CI, 0.863-0.923) and 0.863 (95% CI, 0.831-0.889) among another 4436 lesions from 4097 patients in the 21 studies using supersonic shear imaging. When analysis confined to 9 studies evaluated the diagnostic performance of combination SWE and conventional ultrasound, the area under the curve was 0.96 (95% CI, 0.94-0.97), yielding a sensitivity of 0.971 (95% CI, 0.941-0.986) and specificity of 0.801 (95% CI, 0.733-0.856). SWE seems to be a good quantitative method for differentiating breast lesions, with promise for integration into routine imaging protocols.

Intra- and inter-observer variation and accuracy using different shear wave elastography methods to assess circumscribed objects – a phantom study.

“…In contrast, US elastography yields objective (semi-)quantitative findings on tissue stiffness and also penetrates into regions of the human body previously inaccessible to physicians' hands -except intraoperatively. Other organs or tissues have thus been examined by means of US elastography besides the liver, breasts, and thyroid, for which examination techniques have already been established worldwide [1][2][3].…”

Shear Wave Liver Elastography with a Propagation Map: Diagnostic Performance and Inter-Observer Correlation for Hepatic Fibrosis in Chronic Hepatitis

“…Shear wave elastography of various organs and diseases has been studied by many researchers and has shown promise for non-invasive diagnosis by quantitative measurement of tissue stiffness (Liu et al 2016;Nowicki and Dobruch-Sobczak 2016;Suh et al 2017). Before the development of SWE with a propagation map, there were several commercially available shear wave-based US elastography systems such as acoustic radiation force impulse (ARFI) quantification, Supersonic Shear imaging (SSI) and ElastPQ (Liu et al 2016).…”

“…Before the development of SWE with a propagation map, there were several commercially available shear wave-based US elastography systems such as acoustic radiation force impulse (ARFI) quantification, Supersonic Shear imaging (SSI) and ElastPQ (Liu et al 2016). These methods use focused high-intensity, short-duration acoustic pulses, instead of the mechanical vibration characteristic of TE, to produce shear waves in the target tissue.…”

Non-invasive evaluation of intestinal disorders: The role of elastographic techniques

“…Its application has been validated mainly in the liver setting[41,42], with promising results for kidney[43] and thyroid diseases as well. If the disturbance/deformation induced by the mechanical excitation of the tissue is measured as the velocity of an induced shear wave, the technique is labelled shear wave elastography (SWE, which uses ARFI technology) or transient elastography, the latter being a technology not developed for imaging[40,44]. The successful application of elastography in various clinical scenarios is consistent with the concept that normal and pathologic tissues have different mechanical properties, mainly due to the altered balance of normal, fibrotic and/or inflammatory tissue components.…”