The role of tissue elasticity in the differential diagnosis of benign and malignant breast lesions using shear wave elastography

Abstract

Background Elastography is a promising way to evaluate tissue differences regarding stiffness, and the stiffness of the malignant breast lesions increased at the lesion margin. However, there is a lack of data on the value of the shear wave elastography (SWE) parameters of the surrounding tissue (shell) of different diameter on the diagnosis of benign and malignant breast lesions. Therefore, the purpose of our study was to evaluate the diagnostic performance of shell elasticity in the diagnosis of benign and malignant breast lesions using SWE. Methods Between September 2016 and June 2017, women with breast lesions underwent both conventional ultrasound (US) and SWE. Elastic values of the lesions peripheral tissue were determined according to the shell size, which was automatically drawn along the edge of the lesion using the following software guidelines: (1): 1 mm; (2): 2 mm; and (3): 3 mm. Quantitative elastographic features of the inner lesions and shell, including the elasticity mean (Emean), elasticity maximum (Emax), and elasticity minimum (Emin), were calculated using an online-available software. The receiver operating characteristic curves (ROCs) of the elastographic features was analyzed to assess the diagnostic performance, and the area under curve (AUC) of each elastographic feature was obtained. Logistic regression analysis was used to predict significant factors of malignancy, permitting the design of predictive models. Results This prospective study included 63 breast lesions of 63 women. Of the 63 lesions, 33 were malignant and 30 were benign. The diagnostic performance of Emax-3shell was the highest (AUC = 0.76) with a sensitivity of 60.6% and a specificity of 83.3%. According to stepwise logistic regression analysis, the Emax-3shell and the Emin-3shell were significant predictors of malignancy (p < 0.05). The AUC of the predictive equation was 0.86. Conclusions SWE features, particularly the combination of Emax-3shell and Emin-3shell can improve the diagnosis of breast lesions.

Role of “Stiff Rim” sign obtained by shear wave elastography in diagnosis and guiding therapy of breast cancer

“…Our study offered the automatically plotted 1-3 mm shells around the breast lesion, which helped to calculate the maximum YM at the tumor border. However, unlike previous studies [20,[23][24][25], our results revealed that the presence of the stiff rim sign had the highest diagnostic accuracy rather than those quantitative SWE parameters, especially the E max of 1-3mm shell. We supposed that this is because the shell, which is composed of glandular tissue, may also exist around benign tumors, thus affecting the diagnostic performance of the E max at the shell [12].…”

“…The desmoplastic reaction caused by the peritumoral infiltration of cancer cells into the interstitial tissues increases the peritumoral stiffness 9 , 21 , 22 . Recent studies using this shell-based analysis found that the E max of 1-3mm shell was the most accurate for differential diagnosis of benign and malignant breast lesions 20 , 23 - 25 . Our study offered the automatically plotted 1-3 mm shells around the breast lesion, which helped to calculate the maximum YM at the tumor border.…”

Analysis of the angular influence in the spatial study of mechanical displacements in highly anisotropic media

“…From these displacements on the acoustic axis, we can evaluate the wave phase velocity component (WPVC) of the low frequency induced wave on the acoustic axis at different depths. Thus, It will be possible to derive values for the shear elastic modulus from this parameter in isotropic or transversely isotropic media, approximately one third of the Young's modulus of the medium in soft tissues (Soleimani et al, 2020;Yang et al, 2020;Chen et al, 2018;Skerl et al, 2016b;Suhail et al, 2019). However, the well-known expression of said modulus is no longer valid for triclinic media and, furthermore, a mathematical expression…”

“…Diverse techniques are used to study mechanical properties of tumors, including optical measurements, cantilevers, elastography (Fovargue et al, 2020), and pre-stressed surfaces (Staunton et al, 2016), but additional research on these and new techniques is still needed to understand the cell-microenvironment mechanical interaction. Recent literature describes the relationship between malignant lesions and anisotropy of breast cancer confirmed that malignant lesions are more anisotropic than benign (Sinkus et al, 2001;Skerl et al, 2016aSkerl et al, , 2016bGu et al, 2020;Böl et al, 2014;Soltaninezhad et al, 2020;Soleimani et al, 2020;Yang et al, 2020;Chen et al, 2018). In 2001, R. Sinkus et al observed a tendency of breast tumors to be anisotropic (Sinkus et al, 2001).…”

Machine learning–based diagnostic evaluation of shear-wave elastography in BI-RADS category 4 breast cancer screening: a multicenter, retrospective study

“…Data were retrospectively collected from April 2018 to May 2020. The sample size calculation was based on previously published studies, with an expected sensitivity of 0.8 and an expected specificity of 0.9 used in the final calculation (15)(16)(17). Alpha (α) was 0.05, with an allowable error of 10%.…”