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

Abstract

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.

Breast Involvement by Hematologic Malignancies: Ultrasound and Elastography Findings with Clinical Outcomes

“…[ 12 ] Recently, there is an increasing number of studies assessing the role of ES in detecting breast malignancies, especially primary breast carcinoma. [ 13 14 15 16 ] In addition, ES has been shown to provide additional information in differentiating between benign and malignant breast lesions, and determining biopsy. Strain and Shear Wave ES are two different ES techniques.…”

Classification of breast cancer in ultrasound imaging using a generic deep learning analysis software: a pilot study

“…1 In recent years, it has been demonstrated that the sensitivity for detecting breast cancer can be improved by using ultrasound in addition to mammography particularly in patients with dense breast tissue, 2,3 mainly in younger females. 2 Due to the development of new technologies like shear wave elastography or contrast enhanced ultrasound, 4,5 breast ultrasound is steadily gaining importance in the workup of females with suspected breast cancer. Although, ultrasound requires more of the radiologist's time 6 and is operatordependent, 7 in contrast to mammography it does not entail the usage of ionizing radiation, provides a better soft-tissue contrast and offers the capability to guide a biopsy instrument in real time.…”

High-resolution ultrasonography and shear-wave sonoelastography of a cystic radial nerve Schwannoma

“…For example, invasive ductal carcinoma in situ of the breast has SWE properties of approximately 70 kPa [19]. In addition, a soft SWE value (\50 kPa) combined with benign gray-scale US features may obviate need for biopsy and follow-up with a palpable breast mass in women less than 40 years [20]. In thyroid nodules, using 65 kPa as a cut-off value yields 76% sensitivity and 64% specificity in diagnosing malignancy (i.e., papillary thyroid carcinoma) [10].…”