Highlights
- •Multiparametric SWE values can be affected by lesion-dependent factors such as lesion margin, lesion size, and lesion depth from the skin in benign lesions.
- •The lesion's distance from the nipple, and breast quadrant localization do not have a significant effect on multiparametric SWE values for benign lesions.
- •Elastographically hard BI-RADS 4 lesions have a higher probability of malignancy than the standard risk values (2% –95%).
Rationale and Objectives
To evaluate the shear wave elastography indices (multiparametric SWE) of breast lesions
based on patient and lesion dependent features and assess the contribution of different
elastographic parameters to radiological diagnosis.
Materials and Methods
Effect of patient-dependent (age and menopausal status) and lesion-dependent (distance
from the areola, quadrant location, size, depth, margin and shape) factors on SWE
parameters (Vmean, Vsd, Vmax, Vmin) in benign breast lesions were assessed. Only mass
lesions were included in the study. Sensitivity, specificity, PPV, NPV and cut-off
values for each elastography parameter was calculated.
Results
A total of 496 mass lesions of breast were evaluated. 467 of the lesions were benign
and 29 were malignant. There was no significant relationship among SWE indices and
age, menopausal status, lesion shape and distance to the areola in benign lesions
(p>0.05). SWE indices were found to be associated with lesion margin, depth from the
skin, and lesion size in benign lesions (p<0.05). All BI-RADS 3 lesions that underwent biopsy were benign (n:35); 23.5% of 4a lesions were malignant (n:4/17) and all 4b-4c-5 lesions were malignant
(n:25/25). The cut-off values for malignant lesions were: Vmean 3.38 m/s, Vsd 0.81,
Vmax 6.87 m/s, Vmin 1.53 m/s. All SWE parameters were statistically significant in
predicting malignancy on ROC analysis, Vmax was the most sensitive (96.3%) and specific
(94.7%) parameter. Cut-off values for Vmax was 6.87 m/s with an accuracy rate of 94.7%,
and 3.37 m/s for Vmean and 0.8 for Vsd with 92.5% accuracy.
Conclusion
The SWE parameters to predict malignancy in breast lesions can be affected by lesion
dependent features, whereas no significant effect of patient's age or menopausal status
on stiffness of the lesions was observed. Vmax had the highest sensitivity for predicting
malignancy.
Key Words
Abbreviations:
SWE (Shear wave elastography), PPV (Positive predictive value), NPV (Negative predictive value), US (Ultrasonography), ACR (American College of Radiology), BI-RADS (Breast Imaging-Reporting and Data System), IDC (Invasive ductal carcinoma)To read this article in full you will need to make a payment
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References
- Benign and malignant breast lesions identification through the values derived from shear wave elastography: evidence for the meta-analysis.Oncotarget. 2017; 8: 89173-89181https://doi.org/10.18632/oncotarget.21124
- Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses.Radiology. 2012; 262: 435-449https://doi.org/10.1148/radiol.11110640
- BI-RADS fifth edition: a summary of changes.Diagn Interv Imaging. 2017; 98: 179-190https://doi.org/10.1016/j.diii.2017.01.001
- Breast elastography: a new paradigm in diagnostic breast imaging.Appl Radiol. 2018; 47: 14-19
- Shear wave elastography for the diagnosis of small (≤2 cm) breast lesions: added value and factors associated with false results.Br J Radiol. 2019; 9220180341https://doi.org/10.1259/bjr.20180341
- Overweight, obesity and risk of premenopausal breast cancer according to ethnicity: a systematic review and dose-response meta-analysis.Obes Rev. 2013; 14: 665-678https://doi.org/10.1111/obr.12028
- Changes in the elasticity of fibroadenoma during the menstrual cycle determined by real-time sonoelastography.Eur J Radiol. 2015; 84: 1044-1048https://doi.org/10.1016/j.ejrad.2015.03.006
- Breast mass evaluation: factors influencing the quality of US elastography.Radiology. 2011; 259: 59-64https://doi.org/10.1148/radiol.10101414
- Factors influencing breast elasticity measured by the ultrasound shear wave elastography - preliminary results.Arch Med Sci. 2011; 7: 127-133https://doi.org/10.5114/aoms.2011.20617
- Form and function: how estrogen and progesterone regulate the mammary epithelial hierarchy.J Mammary Gland Biol Neoplasia. 2015; 20: 9-25https://doi.org/10.1007/s10911-015-9337-0
- Exploring association of breast pain, pregnancy, and body mass index with breast tissue elasticity in healthy women: glandular and fat differences.Diagnostics (Basel). 2020; 10: 393https://doi.org/10.3390/diagnostics10060393
- Mammary gland development.Wiley Interdiscip Rev Dev Biol. 2012; 1: 533-557https://doi.org/10.1002/wdev.35
- Breast development and anatomy.Clin Obstet Gynecol. 2011; 54: 91-95https://doi.org/10.1097/GRF.0b013e318207ffe9
- Factors influencing the stiffness of fibroadenomas at shear wave elastography.Clin Radiol. 2016; 71: 92-95https://doi.org/10.1016/j.crad.2015.10.029
- Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors.Radiology. 2012; 263: 673-677https://doi.org/10.1148/radiol.12111317
- Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases.Breast Cancer Res Treat. 2011; 129 (Epub 2011 Jun 17. PMID: 21681447): 89-97https://doi.org/10.1007/s10549-011-1627-7
- Ultrasound shear wave elastography of breast lesions: correlation of anisotropy with clinical and histopathological findings.Cancer Imaging. 2018; 18: 11https://doi.org/10.1186/s40644-018-0144-x
- Use of shear wave elastography to differentiate benign and malignant breast lesions.Diagn Interv Radiol. 2014; 20: 239-244https://doi.org/10.5152/dir.2014.13306
- Differentiating benign from malignant solid breast masses: value of shear wave elastography according to lesion stiffness combined with greyscale ultrasound according to BI-RADS classification.Br J Cancer. 2012; 107: 224-229https://doi.org/10.1038/bjc.2012.253
- Breast ultrasound elastography and magnetic resonance imaging of fibrotic changes of breast disease: correlations between elastography findings and pathologic and short Tau inversion recovery imaging results, including the enhancement ratio and apparent diffusion coefficient.J Comput Assist Tomogr. 2015; 39: 94-101https://doi.org/10.1097/RCT.0000000000000155
- Stiffness of the surrounding tissue of breast lesions evaluated by ultrasound elastography.Eur Radiol. 2014; 24: 1659-1667https://doi.org/10.1007/s00330-014-3152-7
- Predicting prognostic factors of breast cancer using shear wave elastography.Ultrasound Med Biol. 2014; 40: 269-274https://doi.org/10.1016/j.ultrasmedbio.2013.09.028
- Quantitative and qualitative evaluation of breast cancer prognosis: a sonographic elastography study.Med Sci Monit. 2019; 25: 9272-9279https://doi.org/10.12659/MSM.918806
- Stiffness of tumours measured by shear-wave elastography correlated with subtypes of breast cancer.Eur Radiol. 2013; 23: 2450-2458https://doi.org/10.1007/s00330-013-2866-2
- Breast carcinomas: variations in sonoelastographic appearance.Breast Cancer (Dove Med Press). 2014; 6: 135-143https://doi.org/10.2147/BCTT.S66110
- What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography?.Eur Radiol. 2014; 24: 921-926https://doi.org/10.1007/s00330-013-3079-4
- Evaluation of tumor stiffness by elastography is predictive for pathologic complete response to neoadjuvant chemotherapy in patients with breast cancer.Ann Surg Oncol. 2012; 19: 3042-3049https://doi.org/10.1245/s10434-012-2343-1
- Evaluation of the response of breast cancer patients to neoadjuvant chemotherapy by combined contrast-enhanced ultrasonography and ultrasound elastography.Exp Ther Med. 2019; 17: 3655-3663https://doi.org/10.3892/etm.2019.7353
- Shear-wave elastography of the breast: impact of technical image quality parameters on diagnostic accuracy.AJR Am J Roentgenol. 2021; 216: 1205-1215https://doi.org/10.2214/AJR.19.22728
- Visually assessed colour overlay features in shear-wave elastography for breast masses: quantification and diagnostic performance.Eur Radiol. 2013; 23: 658-663https://doi.org/10.1007/s00330-012-2647-3
Article info
Publication history
Published online: October 18, 2021
Accepted:
September 8,
2021
Received in revised form:
September 7,
2021
Received:
July 14,
2021
Footnotes
Conflict of Interest: The authors declare that there is no conflict of interest.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Identification
Copyright
© 2021 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
