The potential of combined shear wave and strain elastography to reduce unnecessary biopsies in breast cancer diagnostics – An international, multicentre trial

Golatta, Michael; Pfob, André; Büsch, Christopher; Brückner, Thomas; Alwafai, Zaher; Balleyguier, Corinne; Clevert, Dirk-André; Duda, Volker; Gonçalo, Manuela; Gruber, Ines; Hahn, Markus; Kapetas, Panagiotis; Öhlinger, R.; Rutten, M.J.C.M.; Togawa, Riku; Tozaki, Mitsuhiro; Wojcinski, Sebastian; Rauch, Geraldine; Heil, Joerg; Barr, Richard G.

doi:10.1016/j.ejca.2021.11.005

Cited by 29 publications

(27 citation statements)

References 18 publications

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“…The range of biopsies is extremely wide. Following the conventional ultrasound recommendations for breast, 53.80% (495 of 920 patients) biopsy was unnecessary ( 10 ). Studies have revealed that CEUS may improve the diagnostic accuracy of breast lesions, especially for BIRADS 4a and 4b lesions ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound of granular cell tumor in breast: A case report with review of the literature

et al. 2022

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Granular cell tumor is an infrequent, predominantly benign tumor originating from Schwann cells. Granular cell tumor of the breast (GCTB) can simulate breast malignant carcinoma on the clinical assessment. We herein present a rare case of GCTB which recurred in the contralateral breast. We believe the contrast-enhanced ultrasound (CEUS) findings of GCTB have never been described. The high similarity of breast malignant carcinoma makes its differential diagnosis difficult on the clinical and radiological features. In this report, we present the CEUS findings from a rare case of GCTB, explore the possible value of CEUS in differential diagnosis between benign breast lesions and malignant ones, and briefly review the literature.

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Section: Introductionmentioning

confidence: 99%

Contrast-enhanced ultrasound of granular cell tumor in breast: A case report with review of the literature

et al. 2022

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“…A recent multicenter trial evaluating the potential of SE ratio and SWE in reducing unnecessary biopsies among breast cancer patients had encouraging results. 15 The authors reported that the addition of both SE ratio and SWE in conventional USG could reduce the rate of unnecessary biopsies in category 4a patients up to 35% while keeping the rate of undetected malignancies lower than 2%. In the present study we evaluated the added advantage of breast elastography as an adjunct to conventional breast USG for more accurate characterization of benign and malignant breast lesions.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of strain elastography and shear wave elastography in differentiating benign and malignant breast lesions

Shahzad¹,

Fatima

Anjum³

et al. 2022

Ann Saudi Med

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BACKGROUND: Conventional B-mode breast ultrasonography, though the primary modality to determine benign or malignant nature of a solid breast lesion, sometimes encounters overlapping sonographic morphological features in a single lesion. Elastography leads to improvement by evaluating the structural aspects and characterization of the lesion as benign or malignant on the basis of multi-parametric assessment. OBJECTIVE: Determine the role of strain elastography (SE) and shear wave elastography (SWE) in differentiating benign and malignant breast lesions. DESIGN: Cross sectional SETTING: Radiology department of hospital PATIENTS AND METHODS: Patients meeting inclusion criteria referred to our hospital for ultrasonography followed by biopsy or surgical excisions were examined with B-mode ultrasonography and by both strain and shear wave elastography. MAIN OUTCOME MEASURES: Mean values of SE and SWE in benign and malignant breast lesions, determination of cutoff using AUC curves and sensitivity and specificity of both techniques. SAMPLE SIZE: One hundred breast lesions from 95 consecutive patients. RESULTS: The mean (SD) strain elastography ratio in the overall patient population was 4.1 (2.0). Cutoff for benign vs. malignant lesions was 2.86 on the ROC curve. The AUC was 0.911 (95%CI; 0.835-0.988: SE, 0.039) with a sensitivity of 95.8% and a specificity of 89.3%. For the SWE kPa values, the ROC curve showed the AUC was 0.929 (95% CI, 0.870-0.988; SE: 0.030, P <.001). Assigning 45.3 as a cut off value provided a sensitivity of 95.8% with a specificity of 85.7%; the positive predictive value was 94.5% and the negative predictive value was 89.6%. The Breast Imaging Reporting and Data System (BI-RADS) category alone was able to differentiate between benign and malignant lesions with a sensitivity of 91.7% and a specificity 100% keeping the cut off value between 4a and 4b. The area under the ROC curve was 0.979. Combining the three (BI-RADS + SE + SWE) distinguished benign vs. malignant lesions with a sensitivity up to 100% and specificity up to 96.3%. CONCLUSION: Combining SE and SWE as a complementary tool with conventional B-mode ultrasonography has a significant potential for better characterization of solid breast lesions and decreasing unnecessary biopsies of BI-RADS IVa lesions. LIMITATIONS: Single institution study. CONFLICT OF INTEREST: None.

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“…It is noteworthy that in SWE, the shear waves generated from acoustic radiation in tissues could be accepted by the ultrasound tracking equipment, thus the elastic modulus (E value) and speed of shear-wave velocity (SWV) of the tissue can both be measured, presenting as kilopascals (kPa) and meters per second (m/s), respectively ( 8 , 9 ). For clinical application especially, SWE has been extensively applied in thyroid ( 10 , 11 ), breast ( 12 , 13 ), liver ( 14 , 15 ), and other organs ( 16 – 18 ) due to its effective diagnosis through qualitative and quantitative evaluation of tissue stiffness using color map and SWV ( 1 ). Featured with non-invasive and quick operating, it could be applied especially in LN detection.…”

Section: Introductionmentioning

confidence: 99%

Differential Diagnosis Value of Shear-Wave Elastography for Superficial Enlarged Lymph Nodes

Sun

Wang

et al. 2022

Front. Oncol.

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ObjectivesTo evaluate the diagnostic efficiency and diagnostic threshold of conventional US and shear-wave elastography (SWE) in superficial enlarged lymph nodes (LNs).MethodsA total of 204 patients with superficial enlarged LNs were enrolled in this retrospective study aged 46.0 ± 15.2 years from March 2020 to March 2021. LNs with a long axis larger than 0.7 cm were considered as superficial enlarged. Before the histological biopsy, LNs that were considered suspicious according to both conventional US and SWE were included, while LNs with no or unclear pathological results, or with no satisfactory SWE images, were excluded. The conventional and 2-D SWE examinations were performed with Aplio i800 and Acuson sequoia equipped with i18LX5 linear-array transducer (5-18 MHz) and 10L4 linear-array transducer (4-10 MHz), respectively. Both E Median and Vs Median parameters were investigated by two senior ultrasound physicians. The pathological results were performed as the gold standard.ResultsVariables including transverse axis size, lymphatic hilum, L/T ratio, echogenicity, and color Doppler pattern were considered significant. The mean E Median value in benign, metastatic LNs, and lymphoma were 28.26 ± 8.87 kPa, 77.46 ± 22.85 kPa, and 50.37 ± 5.41 kPa (p <0.001), while Vs Median values were 3.02 ± 0.50 m/s, 4.87 ± 0.90 m/s, and 4.09 ± 0.22 m/s, respectively (p < 0.001). The diagnostic performance indicated the high sensitivity, specificity, PPV, NPV, and overall accuracy of conventional US combined with SWE. The optimal cutoff values of E Median and Vs Median for predicting malignant LNs were 42.90 kPa and 3.73 m/s, respectively. As AUC value, sensitivity, specificity, accuracy, PPV, and NPV revealed, the indexes of E Median were 0.976, 0.927, 0.975, 0.946, 0.983, and 0.897, respectively, while Vs Median were 0.970, 0.927, 0.963, 0.941, 0.975, and 0.895, respectively (p <0.001). The ROC curves of both E Median (AUC=0.976) Vs Median (AUC=0.970) suggested the remarkable diagnostic efficiency in distinguishing benignity between suspected malignant LNs.ConclusionsAbove results indicated that conventional US together with 2-D SWE could elevate the diagnostic performance. Meanwhile, the parameters of 2-D SWE including E Median and Vs Median could effectively assess malignant LNs, which provide valuable differentiating information in superficial enlarged LNs.

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The potential of combined shear wave and strain elastography to reduce unnecessary biopsies in breast cancer diagnostics – An international, multicentre trial

Cited by 29 publications

References 18 publications

Contrast-enhanced ultrasound of granular cell tumor in breast: A case report with review of the literature

Contrast-enhanced ultrasound of granular cell tumor in breast: A case report with review of the literature

Diagnostic value of strain elastography and shear wave elastography in differentiating benign and malignant breast lesions

Differential Diagnosis Value of Shear-Wave Elastography for Superficial Enlarged Lymph Nodes

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