Role Of Shear Wave Elastography In The Diagnosis Of Small Malignant Breast Lesions

Abstract

Background:Breast cancer incidence is increasing, and conventional imaging is limited, particularly in dense breasts and indeterminate lesions, necessitating the use of advanced techniques like elastography for improved diagnostic accuracy.

Aim: To examine the performance of 2D Shear Wave Elastography (SWE) combined with BI-RADS classification of greyscale ultrasound images in the characterization of small breast lesions.

Patients and methods:This research was a prospective analysis that involved 91 women with 100 lesions of breast, who had been referred to the radio-diagnosis departments at Baheya Institute and National Cancer Institute in the intervals from January 2022 to December 2024.

Results:The US-BI-RADS alone showed good diagnostic performance (sensitivity 83.3%, specificity 95.5%, accuracy 89.47%, κ = 0.805, p < 0.001). When combined with qualitative SWE, diagnostic accuracy improved (sensitivity 95%, specificity 91.1%, accuracy 92.7%, κ = 0.849). The combined analysis of both conventional US-BIRADS and quantitative SWE (lesion elasticity) had a sensitivity of 98.3%, specificity of 92.2%, positive predictive value of 89.39%, negative predictive value of 98.8% and accuracy of 95.25% in distinguishing malignant from benign breast lesions. The combined approach allowed for more accurate lesion classification, including downgrading 12 benign cases and upgrading 9 suspicious ones, some of which were confirmed malignancies (e.g., tubular and mucinous carcinoma).

Conclusion:SWE enhances breast lesion identification when combined with B-mode ultrasound, but accuracy may be influenced by lesion location, necessitating careful use and further guideline development.

Background:Breast cancer incidence is increasing, and conventional imaging is limited, particularly in dense breasts and indeterminate lesions, necessitating the use of advanced techniques like elastography for improved diagnostic accuracy.

Aim: To examine the performance of 2D Shear Wave Elastography (SWE) combined with BI-RADS classification of greyscale ultrasound images in the characterization of small breast lesions.

Patients and methods:This research was a prospective analysis that involved 91 women with 100 lesions of breast, who had been referred to the radio-diagnosis departments at Baheya Institute and National Cancer Institute in the intervals from January 2022 to December 2024.

Results:The US-BI-RADS alone showed good diagnostic performance (sensitivity 83.3%, specificity 95.5%, accuracy 89.47%, κ = 0.805, p < 0.001). When combined with qualitative SWE, diagnostic accuracy improved (sensitivity 95%, specificity 91.1%, accuracy 92.7%, κ = 0.849). The combined analysis of both conventional US-BIRADS and quantitative SWE (lesion elasticity) had a sensitivity of 98.3%, specificity of 92.2%, positive predictive value of 89.39%, negative predictive value of 98.8% and accuracy of 95.25% in distinguishing malignant from benign breast lesions. The combined approach allowed for more accurate lesion classification, including downgrading 12 benign cases and upgrading 9 suspicious ones, some of which were confirmed malignancies (e.g., tubular and mucinous carcinoma).

Conclusion:SWE enhances breast lesion identification when combined with B-mode ultrasound, but accuracy may be influenced by lesion location, necessitating careful use and further guideline development.