US-Elastography for Breast Lesion Characterization: Prospective Comparison of US BIRADS, Strain Elastography and Shear wave Elastography

Abstract

Purpose To evaluate the diagnostic performance of strain elastography (SE) and 2 D shear wave elastography (SWE) and SE/SWE combination in comparison with conventional multiparametric ultrasound (US) with respect to improving BI-RADS classification results and differentiating benign and malignant breast lesions using a qualitative and quantitative assessment.

Materials and Methods In this prospective study, 130 histologically proven breast masses were evaluated with baseline US, color Doppler ultrasound (CDUS), SE and SWE (Toshiba Aplio 500 with a 7–15 MHz wide-band linear transducer). Each lesion was classified according to the BIRADS lexicon by evaluating the size, the B-mode and color Doppler features, the SE qualitative (point color scale) and SE semi-quantitative (strain ratio) methods, and quantitative SWE. Histological results were compared with BIRADS, strain ratio (SR) and shear wave elastography (SWE) all performed by one investigator blinded to the clinical examination and mammographic results at the time of the US examination. The area under the ROC curve (AUC) was calculated to evaluate the diagnostic performance of B-mode US, SE, SWE, and their combination.

Results Histological examination revealed 47 benign and 83 malignant breast lesions. The accuracy of SR was statistically significantly higher than SWE (sensitivity, specificity and AUC were 89.2 %, 76.6 % and 0.83 for SR and 72.3 %, 66.0 % and 0.69 for SWE, respectively, p = 0.003) but not higher than B-mode US (B-mode US sensitivity, specificity and AUC were 85.5 %, 78.8 %, 0.821, respectively, p = 1.000).

Conclusion Our experience suggests that conventional US in combination with both SE and SWE is a valid tool that can be useful in the clinical setting, can improve BIRADS category assessment and may help in the differentiation of benign from malignant breast lesions, with SE having higher accuracy than SWE.

Zusamenfassung

Ziel Evaluierung der diagnostischen Leistung der Strain-Elastografie (SE) und der 2D-Scherwellen-Elastografie (SWE) sowie der SE/SWE-Kombination im Vergleich zum konventionellen multiparametrischen Ultraschall (US) zur Verbesserung der Ergebnisse der BI-RADS-Klassifikation und zur Differenzierung benigner und maligner Brustläsionen mittels einer qualitativen und quantitativen Bewertung.

Material und Methoden In dieser prospektiven Studie wurden 130 histologisch nachgewiesene Raumforderungen der Brust mit Basis-US, Farbdoppler-Ultraschall (CDUS), SE und SWE (Toshiba Aplio 500 mit einem 7–15MHz-Breitband-Linearschallkopf) bewertet. Jede Läsion wurde nach dem BIRADS-Lexikon klassifiziert, indem die Größe, die B-Modus- und Farbdoppler-Merkmale, die qualitativen (Punkt-Farbskala) und semiquantitativen (Strain-Ratio) SE-Methoden sowie die quantitative SWE bewertet wurden. Die histologischen Ergebnisse wurden mit BI-RADS, Strain-Ratio (SR) und Scherwellen-Elastografie (SWE) verglichen, die alle von demselben Untersucher durchgeführt wurden, der zum Zeitpunkt der US-Untersuchung gegenüber der klinischen Untersuchung und den mammografischen Ergebnissen verblindet war. Die Fläche unter der ROC-Kurve (AUC) wurde berechnet, um die diagnostische Leistung von B-Mode-US, SE, SWE und deren Kombination zu bewerten.

Ergebnisse Die histologische Untersuchung ergab 47 gutartige und 83 bösartige Brustläsionen. Die Genauigkeit der SR war statistisch signifikant höher als bei der SWE (Sensitivität 89,2 vs. 72,3 %; Spezifität 76,6 vs. 66,0 %; AUC 0,83 vs. 0,69; p = 0,003), aber nicht höher als beim B-Modus-US (Sensitivität 85,5 %; Spezifität 78,8 %; AUC 0,821; p = 1,000).

Schlussfolgerung Nach unserer Erfahrung sind der konventionelle US in Kombination mit beiden, SE und SWE, gültige Methoden, die im klinischen Alltag nützlich sein können, um die Beurteilung der BI-RADS-Kategorie zu verbessern und die Differenzierung von gutartigen und bösartigen Brustläsionen zu unterstützen – bei höherer Genauigkeit der SE als der SWE.

Key words

breast lesions - characterization - shear wave elastography - strain elastography - BIRADS

Publication History

Received: 15 January 2020

Accepted: 18 February 2020

Article published online:
24 April 2020

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