Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases

Chang, Jung Min; Moon, Wookyung; Cho, Nariya; Yi, Ann; Koo, Hye Ryoung; Han, Wonshik; Noh, Dong‐Young; Moon, Hye-Jin; Kim, Seung Ja

doi:10.1007/s10549-011-1627-7

Cited by 307 publications

(236 citation statements)

References 17 publications

(30 reference statements)

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“…[18][19][20] When elastography was used to downgrade BI-RADS category 4a lesions, the malignancy rate increased from 7% to 9% with ultrasound BI-RADS assessment alone to 17-18% with ultrasound BI-RADS plus elastography. 15,21 In this study, the estimated risk of malignancy in ultrasound 4a lesions was 8.5% (11/130); however, this rate was increased to 10.9% (6/55) when both ultrasound and MRI findings were positive.…”

Section: Discussionmentioning

confidence: 99%

Additional diagnostic value of MRI in patients with suspicious breast lesions based on ultrasound

Sarıca¹,

Uluc²

2014

BJR

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Objective: Biopsy has long been the standard approach in Breast Imaging Reporting and Data System® (BI-RADS) 4 or BI-RADS 5 (American College of Radiology, Reston, VA) lesions despite a wide variation in reported incidence of malignancy in BI-RADS 4 lesions. This study examined the diagnostic value of breast MRI as well as its ability to decrease unnecessary biopsies in patients with solid breast lesions who had an indication for biopsy. Methods: In this retrospective study, 277 breast lesions with a documented histological diagnosis as established by ultrasound-guided biopsy were included. All patients were female, and biopsy was performed owing to a BI-RADS score of 4 or 5 on ultrasonography. In addition, all patients had undergone MRI before biopsy. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI in predicting malignancy were calculated.Results: When all lesions were analysed, sensitivity, specificity, NPV and PPV of MRI in detecting malignancy were 94.2%, 56.1%, 90.7% and 68.1%, respectively. When only ultrasonographic BI-RADS 4 lesions are considered, the corresponding figures were as follows: 90.9%, 56.7%, 93.8% and 46.4%, respectively. False-negative rate of MRI for the latter group of lesions was 2.6%. 42% of unnecessary biopsies were avoided in sonographic BI-RADS 4 lesions. Conclusion: Despite promising results obtained in this study, dynamic MRI currently does not seem to be effective in ruling out the need for biopsy in the assessment of sonographic BI-RADS 4 lesions. However, advanced MRI techniques may assist in improving possible benefits of MRI in this patient group.

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Section: Discussionmentioning

confidence: 99%

Additional diagnostic value of MRI in patients with suspicious breast lesions based on ultrasound

Sarıca¹,

Uluc²

2014

BJR

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“…SWE revealed a sensitivity and specificity in the discrimination between benign and malignant lesions of 97% and 95%, respectively. For the assessment of the dignity of these masses, the optimal cut-off mean, maximum, and minimum values were stated to be 45.7 kPa, 54.3 kPa, and 37.1 kPa, respectively 12 . Experience with SWE in prostate lesions has also been promising.…”

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confidence: 99%

Shear wave elastography parameters of normal soft tissues of the neck

Herman¹,

Sedláčková²,

Vachutka³

et al. 2017

BIOMED PAP

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Background. Shear wave elastography is a relatively new method of quantitative measurement of tissue elasticity. Assuming that malignant lesions are stiffer than benign ones, elastography may provide supplementary information for their discrimination. However, potential confounding factors impacting tissue stiffness should be investigated first. Aims. The objective of this study was to measure the stiffness of selected tissues of the head and neck in a normal population and to evaluate its relationship to age, sex, and body mass index. Methods. Stiffness of the thyroid, submandibular and parotid glands, masseter and sternocleidomastoid muscles, and cervical lymph nodes was measured bilaterally in 128 healthy volunteers (83 female and 45 male). At least 20 subjects in each decade of life (20-29, 30-39…, 70+) were enrolled. Shear wave elastography was performed by a single radiologist in all the subjects. The stiffnesses obtained were correlated with age, sex, and body mass index. Results. The mean stiffness was 9.5 ± 3.6 kPa for the thyroid, 9.5 ± 4.6 kPa for the lymph node, 11.0 ± 3.4 kPa for the submandibular gland, 9.0 ± 3.5 kPa for the parotid gland, 9.9 ± 4.1 kPa for the sternocleidomastoid, and 10.0 ± 4.3 kPa for the masseter muscle. A slight general decrease in stiffness with increasing age was found. BMI and weight had a small impact on the minimum and maximum stiffness values. The sex of the subject did not affect elasticity. Conclusion. The mean stiffness of healthy head and neck organs has a relatively narrow distribution around 11 kPa. The changes of stiffness with age, BMI, and weight that were identified are too small to have clinical impact.

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“…It has been shown to yield accurate information with regard to benign/malignant differentiation of solid breast masses. [1][2][3] SWE allows measurement of the propagation speed of shear waves within the tissue, to locally quantify its stiffness in kilopascals or metre per second. A variety of quantitative measures can be obtained with SWE, including the mean, maximum and "standard deviation" from a user-defined region of interest (ROI).…”

Section: Introductionmentioning

confidence: 99%

“…Qualitative assessments have also been found to be useful (shape at SWE, pattern of stiffness and heterogeneity of stiffness). [1][2][3][4][5] Several large studies have shown that the addition of SWE to greyscale ultrasound improves the performance of ultrasound in differentiating benign from malignant breast masses. 1,3,6 Notably, the combination of benign SWE and greyscale ultrasound findings has been shown to be highly specific, and malignancy is extremely unlikely, with a negative-predictive value for the combination of 100%.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5] Several large studies have shown that the addition of SWE to greyscale ultrasound improves the performance of ultrasound in differentiating benign from malignant breast masses. 1,3,6 Notably, the combination of benign SWE and greyscale ultrasound findings has been shown to be highly specific, and malignancy is extremely unlikely, with a negative-predictive value for the combination of 100%. 6 The SWE parameter of mean stiffness is highly accurate in differentiating between benign and malignant solid breast masses and has performance parameters at least as good as the Breast Imaging Reporting and Data System (BI-RADS) evaluation of greyscale images.…”

Section: Introductionmentioning

confidence: 99%

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Shear-wave elastography and greyscale assessment of palpable probably benign masses: is biopsy always required?

Giannotti¹,

Vinnicombe²,

Thomson³

et al. 2016

BJR

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Objective: To establish if palpable breast masses with benign greyscale ultrasound features that are soft on shear-wave elastography (SWE) (mean stiffness ,50 kPa) have a low enough likelihood of malignancy to negate the need for biopsy or follow-up. Methods: The study group comprised 694 lesions in 682 females (age range 17-95 years, mean age 56 years) presenting consecutively to our institution with palpable lesions corresponding to discrete masses at ultrasound. All underwent ultrasound, SWE and needle core biopsy. Static greyscale images were retrospectively assigned Breast Imaging Reporting and Data System (BI-RADS) scores by two readers blinded to the SWE and pathology findings, but aware of the patient's age. A mean stiffness of 50 kPa was used as the SWE cut-off for calling a lesion soft or stiff. Histological findings were used to establish ground truth. Results:No cancer had benign characteristics on both modalities. 466 (99.8%) of the 467 cancers were classified BI-RADS 4a or above. The one malignant lesion classified as BI-RADS 3 was stiff on SWE. 446 (96%) of the 467 malignancies were stiff on SWE. No cancer in females under 40 years had benign SWE features. 74 (32.6%) of the 227 benign lesions were BI-RADS 3 and soft on SWE; so, biopsy could potentially have been avoided in this group. Conclusion: Lesions which appear benign on greyscale ultrasound and SWE do not require percutaneous biopsy or short-term follow-up, particularly in females under 40 years. Advances in knowledge: None of the cancers had benign characteristics on both greyscale ultrasound and SWE, and 32% of benign lesions were BI-RADS 3 and soft on SWE; lesions that are benign on both ultrasound and SWE may not require percutaneous biopsy or short-term follow-up.

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Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases

Cited by 307 publications

References 17 publications

Additional diagnostic value of MRI in patients with suspicious breast lesions based on ultrasound

Additional diagnostic value of MRI in patients with suspicious breast lesions based on ultrasound

Shear wave elastography parameters of normal soft tissues of the neck

Shear-wave elastography and greyscale assessment of palpable probably benign masses: is biopsy always required?

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