Rationale and Objectives
To develop a simple ultrasound (US) based scoring system to reduce benign breast biopsies.
Materials and Methods
Women with BI-RADS 4 or 5 breast lesions underwent shear-wave elastography (SWE) imaging
before biopsy. Standard US and color Doppler US (CDUS) parameters were recorded, and
the size ratio (SzR=longest/shortest diameter) was calculated. Measured/calculated SWE parameters were
minimum (SWVMin) and maximum (SWVMax) shear velocity, velocity heterogeneity (SWVH=SWVMax-SWVMin), velocity ratio (SWVR=SWVMin/SWVMax), and normalized SWVR (SWVRn=(SWVMax-SWVMin)/SWVMin). Linear regression analysis was performed by converting continuous parameters into
categorical corresponding equivalents using decision tree analyses. Linear regression
models were fitted using stepwise regression analysis and optimal coefficients for
the predictors in the models were determined. A scoring model was devised from the
results and validated using a different data set from another center consisting of
187 cases with BI-RADS 3, 4, and 5 lesions.
Results
A total of 418 lesions (238 benign, 180 malignant) were analyzed. US and CDUS parameters
exhibited poor (AUC=0.592-0.696), SWE parameters exhibited poor-good (AUC=0.607-0.816)
diagnostic performance in benign/malignant discrimination. Linear regression models
of US+CDUS and US+SWE parameters revealed an AUC of 0.819 and 0.882, respectively.
The developed scoring system could have avoided biopsy in 37.8% of benign lesions
while missing 1.1% of malignant lesions. The scoring system was validated with a 100%
NPV rate with a specificity of 74.6%.
Conclusion
The linear regression model using US+SWE parameters performed better than any single
parameter alone. The developed scoring method could lead to a significant decrease
in benign biopsies.
Key Words
Abbreviations:
SzR (lesion size ratio), SWVMin (minimum shear velocity), SWVMax (maximum shear velocity), SWVH (shear velocity heterogeneity), SWVR (velocity ratio), SWVRn (normalized velocity ratio), SSUS (US based scoring system), SSUS SWE (US and SWE based scoring system)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 16, 2023
Accepted:
January 17,
2023
Received in revised form:
January 15,
2023
Received:
November 7,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
