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 Jul 10;107(2):224-9. doi: 10.1038/bjc.2012.253. Epub 2012 Jun 12.

Abstract

Background: The aim of this study was to assess the performance of shear wave elastography combined with BI-RADS classification of greyscale ultrasound images for benign/malignant differentiation in a large group of patients.

Methods: One hundred and seventy-five consecutive patients with solid breast masses on routine ultrasonography undergoing percutaneous biopsy had the greyscale findings classified according to the American College of Radiology BI-RADS. The mean elasticity values from four shear wave images were obtained.

Results: For mean elasticity vs greyscale BI-RADS, the performance results against histology were sensitivity: 95% vs 95%, specificity: 77% vs 69%, Positive Predictive Value (PPV): 88% vs 84%, Negative Predictive Value (NPV): 90% vs 91%, and accuracy: 89% vs 86% (all P>0.05). The results for the combination (positive result from either modality counted as malignant) were sensitivity 100%, specificity 61%, PPV 82%, NPV 100%, and accuracy 86%. The combination of BI-RADS greyscale and shear wave elastography yielded superior sensitivity to BI-RADS alone (P=0.03) or shear wave alone (P=0.03). The NPV was superior in combination compared with either alone (BI-RADS P=0.01 and shear wave P=0.02).

Conclusion: Together, BI-RADS assessment of greyscale ultrasound images and shear wave ultrasound elastography are extremely sensitive for detection of malignancy.

MeSH terms

  • Adult
  • Biopsy / methods
  • Breast Diseases / diagnosis*
  • Breast Diseases / diagnostic imaging
  • Breast Diseases / pathology
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / diagnostic imaging
  • Breast Neoplasms / pathology
  • Diagnosis, Differential
  • Elasticity Imaging Techniques / methods
  • Female
  • Humans
  • Predictive Value of Tests
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ultrasonography, Mammary / methods