Anisotropy of Solid Breast Lesions in 2D Shear Wave Elastography is an Indicator of Malignancy

Published:November 09, 2015DOI:

      Rationale and Objectives

      To investigate if anisotropy at two-dimensional shear wave elastography (SWE) suggests malignancy and whether it correlates with prognostic and predictive factors in breast cancer.

      Materials and Methods

      Study group A of 244 solid breast lesions was imaged with SWE between April 2013 and May 2014. Each lesion was imaged in radial and in antiradial planes, and the maximum elasticity, mean elasticity, and standard deviation were recorded and correlated with benign/malignant status, and if malignant, correlated with conventional predictive and prognostic factors. The results were compared to a study group B of 968 solid breast lesions, which were imaged in sagittal and in axial planes between 2010 and 2013.


      Neither benign nor malignant lesion anisotropy is plane dependent. However, malignant lesions are more anisotropic than benign lesions (P ≤ 0.001). Anisotropy correlates with increasing elasticity parameters, breast imaging-reporting and data system categories, core biopsy result, and tumor grade. Large cancers are significantly more anisotropic than small cancers (P ≤ 0.001). The optimal anisotropy cutoff threshold for benign/malignant differentiation of 150 kPa2 achieves the best sensitivity (74%) with a reasonable specificity (63%).


      Anisotropy may be useful during benign/malignant differentiation of solid breast masses using SWE. Anisotropy also correlates with some prognostic factors in breast cancer.

      Key Words

      Abbreviations and Acronyms:

      AD (anisotropic difference (difference of the measurements in each plane)), AF (anisotropy factor (square of AD)), AUC (area under the curve (statistic measurement to evaluate the diagnostic performance of a method)), E (Young's modulus (measurement unit of tissue elasticity)), Emax (maximum elasticity), Emean (mean elasticity), ROC (receiver operator characteristics (statistical tool to evaluate the diagnostic performance of a method)), ROI (region of interest), SD (standard deviation), SWE (shear wave elastography (elastography technique used in the paper))
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