Shearwave Elastography in Differentiating Benign and Malignant Breast Lesions

Abstract

Shearwave elastography is a new advance technique of the ultrasound with ultrafast shearwave mode which displays evaluation of the elasticity in real time. As the disease process tend to affect stiffness of the tissue thereby distorting its architecture. This architectural change makes the basic principal of the palpation part of the clinical examination. The shearwave elastography uses the principal of palpation. The output of shearwave is displayed in qualitative mode in the form of color change (ranging from blue to red) and quantitative mode as measure of elasticity in kilopascals (ranging from 0 to 300). The soft tissues are penetrated easily giving a homogenous pattern with blue to green color while cancers show color from red to dark red portraying high elasticity. The scoring system for interpretation of the shearwave results suggest that benign lesions show less (i.e., <200 kPa) elasticity while cancers reach high levels (upto 300 kPa). Shearwave elastography has shown superiority as compared to B-mode ultrasound and mammogram in determining the nature of the breast lesions. It has shown high sensitivity in BIRAD 3 and 4 lesions to downgrade and helps in making accurate diagnosis. It has also shown potential in predicting response of neoadjuvant chemotherapy.