Elastic Modulus and Elasticity Ratio of Malignant Breast Lesions with Shear Wave Ultrasound Elastography: Variations with Different Region of Interest and Lesion Size

Shear wave elastography (SWE) is a type of ultrasound elastography with which the elastic properties of breast tissues can be quantitatively assessed. The purpose of this study was to determine the impact of different regions of interest (ROI) and lesion size on the performance of SWE in differentiating malignant breast lesions. The study included 150 female patients with histopathologically confirmed malignant breast lesions. Minimal (Emin), mean (Emean), maximal (Emax) elastic modulus and elasticity ratio (e-ratio) values were measured using a circular ROI size of 2, 4 and 6 mm diameters and the lesions were divided into large (diameter ≥ 15 mm) and small (diameter < 15 mm). Highest Emin, Emean and e-ratio values and lowest variability were observed when using the 2 mm ROI. Emax values did not differ between different ROI sizes. Larger lesions had significantly higher Emean and Emax values, but there was no difference in e-ratio values between lesions of different sizes. In conclusion, when measuring the Emin, Emean and e-ratio of malignant breast lesions using SWE the smallest possible ROI size should be used regardless of lesion size. ROI size has no impact on Emax values while lesion size has no impact on e-ratio values.

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Impact of region of interest (ROI) size on the diagnostic performance of shear wave elastography in differentiating solid breast lesions

Acta Radiologica ◽

10.1177/0284185117732097 ◽

2017 ◽

Vol 59 (6) ◽

pp. 657-663 ◽

Cited By ~ 10

Author(s):

Jin Hee Moon ◽

Ji-Young Hwang ◽

Jeong Seon Park ◽

Sung Hye Koh ◽

Sun-Young Park

Keyword(s):

Shear Wave ◽

Sensitivity And Specificity ◽

Diagnostic Performance ◽

Characteristic Curve ◽

Region Of Interest ◽

Shear Wave Elastography ◽

Breast Lesions ◽

Malignant Breast ◽

Solid Lesions ◽

The Impact

Background Shear wave elastography (SWE) using a region of interest (ROI) can demonstrate the quantitative elasticity of breast lesions. Purpose To prospectively evaluate the impact of two different ROI sizes on the diagnostic performance of SWE for differentiating benign and malignant breast lesions. Material and Methods A total of 154 breast lesions were included. Two types of ROIs were investigated: one involving an approximately 2-mm diameter, small round ROIs placed over the stiffest area of the lesion, as determined by SWE (ROI-S); and another ROI drawn along the margin of the lesion using a touch pen or track ball to encompass the entire lesion (ROI-M). Maximum elasticity (Emax), mean elasticity (Emean), minimum elasticity (Emin), and standard deviation (SD) were measured for the two ROIs. The area under the receiver operating characteristic curve (AUC) as well as the sensitivity and specificity of each elasticity value were determined. Results The AUCs for ROI-S were higher than those for ROI-M when differentiating benign and malignant breast solid lesions. The Emax, Emean, Emin, and SD of the elasticity values for ROI-S were 0.865, 0.857, 0.816, and 0.849, respectively, and for ROI-M were 0.820, 0.780, 0.724, and 0.837, respectively. However, only Emax ( P = 0.0024) and Emean ( P = 0.0015) showed statistically significant differences. For ROI-S, the sensitivity and specificity of Emax were 78.8% and 84.3%, respectively, and those for Emean were 80.8% and 81.4%, respectively. Conclusion Using ROI-S with Emax and Emean has better diagnostic performance than ROI-M for differentiating between benign and malignant breast lesions.

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A Set of Shear Wave Elastography Quantitative Parameters Combined with Ultrasound BI-RADS to Assess Benign and Malignant Breast Lesions

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2014.11.014 ◽

2015 ◽

Vol 41 (4) ◽

pp. 960-966 ◽

Cited By ~ 12

Author(s):

Xian Quan Shi ◽

Jun Lai Li ◽

Wen Bo Wan ◽

Yan Huang

Keyword(s):

Shear Wave ◽

Shear Wave Elastography ◽

Breast Lesions ◽

Quantitative Parameters ◽

Malignant Breast

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Use of shear wave elastography to differentiate benign and malignant breast lesions

Diagnostic and Interventional Radiology ◽

10.5152/dir.2014.13306 ◽

2014 ◽

Vol 20 (3) ◽

pp. 239-244 ◽

Cited By ~ 40

Author(s):

Deniz Cebi Olgun ◽

Bora Korkmazer ◽

Fahrettin Kilic ◽

Atilla Suleyman Dikici ◽

Mehmet Velidedeoglu ◽

...

Keyword(s):

Shear Wave ◽

Shear Wave Elastography ◽

Breast Lesions ◽

Malignant Breast

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Benign and malignant breast lesions identification through the values derived from shear wave elastography: evidence for the meta-analysis

Oncotarget ◽

10.18632/oncotarget.21124 ◽

2017 ◽

Vol 8 (51) ◽

pp. 89173-89181 ◽

Cited By ~ 3

Author(s):

Yan Xue ◽

Shuxin Yao ◽

Xiaodong Li ◽

Huarong Zhang

Keyword(s):

Shear Wave ◽

Meta Analysis ◽

Shear Wave Elastography ◽

Breast Lesions ◽

Malignant Breast

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The role of tissue elasticity in the differential diagnosis of benign and malignant breast lesions using shear wave elastography

BMC Cancer ◽

10.1186/s12885-020-07423-x ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Hui Yang ◽

Yongyuan Xu ◽

Yanan Zhao ◽

Jing Yin ◽

Zhiyi Chen ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Shear Wave ◽

Logistic Regression Analysis ◽

Diagnostic Performance ◽

Shear Wave Elastography ◽

Surrounding Tissue ◽

Breast Lesions ◽

Tissue Elasticity ◽

Malignant Breast

Abstract Background Elastography is a promising way to evaluate tissue differences regarding stiffness, and the stiffness of the malignant breast lesions increased at the lesion margin. However, there is a lack of data on the value of the shear wave elastography (SWE) parameters of the surrounding tissue (shell) of different diameter on the diagnosis of benign and malignant breast lesions. Therefore, the purpose of our study was to evaluate the diagnostic performance of shell elasticity in the diagnosis of benign and malignant breast lesions using SWE. Methods Between September 2016 and June 2017, women with breast lesions underwent both conventional ultrasound (US) and SWE. Elastic values of the lesions peripheral tissue were determined according to the shell size, which was automatically drawn along the edge of the lesion using the following software guidelines: (1): 1 mm; (2): 2 mm; and (3): 3 mm. Quantitative elastographic features of the inner lesions and shell, including the elasticity mean (Emean), elasticity maximum (Emax), and elasticity minimum (Emin), were calculated using an online-available software. The receiver operating characteristic curves (ROCs) of the elastographic features was analyzed to assess the diagnostic performance, and the area under curve (AUC) of each elastographic feature was obtained. Logistic regression analysis was used to predict significant factors of malignancy, permitting the design of predictive models. Results This prospective study included 63 breast lesions of 63 women. Of the 63 lesions, 33 were malignant and 30 were benign. The diagnostic performance of Emax-3shell was the highest (AUC = 0.76) with a sensitivity of 60.6% and a specificity of 83.3%. According to stepwise logistic regression analysis, the Emax-3shell and the Emin-3shell were significant predictors of malignancy (p < 0.05). The AUC of the predictive equation was 0.86. Conclusions SWE features, particularly the combination of Emax-3shell and Emin-3shell can improve the diagnosis of breast lesions.

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Usefulness of Elastography for the Evaluation of Subcentimeter Solid Breast Nodules

Applied Sciences ◽

10.3390/app11041409 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1409

Author(s):

Florentina Guzmán-Aroca ◽

Yésica Martínez-Paredes ◽

Juan de Dios Berná-Serna ◽

Ana Azahara García-Ortega ◽

Juan de Dios Berná-Mestre ◽

...

Keyword(s):

Shear Wave ◽

Correct Diagnosis ◽

Shear Wave Elastography ◽

Accurate Diagnosis ◽

Breast Lesions ◽

Diagnostic Strategy ◽

Benign Lesions ◽

Ultrasound Study ◽

Malignant Breast ◽

Malignant Lesions

The accurate diagnosis of subcentimeter lesions is controversial, and therefore a standardized diagnosis algorithm is needed. The objective of the present work was to study the value of the elastography patterns obtained through the use of the shear wave elastography (SWE) technique with respect to histopathology for the evaluation of nodular breast lesions ≤1 cm. A retrospective study was conducted which included 65 sub-centimeter lesions from 57 patients with an average age of 45.6 ± 11.9. For all the cases, a B-mode ultrasound study, shear wave elastography, and a posterior anatomopathological study were conducted. The lesions had a diameter greater than 7.5 ± 1.7 mm (range: 4–9 mm). Through elastography, the distribution of the patterns was: cyst artifact (n = 13), pattern 1 (n = 4), pattern 2 (n = 31), pattern 3 (n = 13), and pattern 4 (n = 4). Of the 65 lesions, 15 were cysts, 46 were solid benign lesions, and 3 were malignant lesions. The sensitivity of the elastography was 75%, with a specificity of 98.46% and a correct diagnosis in 96.92% of the cases (n = 63). The results from this study show the usefulness of SWE for the evaluation of sub-centimeter breast lesions. In addition, this diagnostic strategy helps with the differential diagnosis between benign and malignant lesions and contributes to the early detection of malignant breast lesions.

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A Prospective Two Center Study Comparing Breast Cancer Lesion Size Defined by 2D Shear Wave Elastography, B-Mode Ultrasound, and Mammography with the Histopathological Size

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-0661-5952 ◽

2018 ◽

Vol 40 (02) ◽

pp. 212-220 ◽

Cited By ~ 1

Author(s):

Andre Farrokh ◽

Linn Treu ◽

Ralf Ohlinger ◽

Carolin Flieger ◽

Nicolai Maass ◽

...

Keyword(s):

Breast Cancer ◽

Shear Wave ◽

Tumor Size ◽

Lobular Carcinoma ◽

Shear Wave Elastography ◽

Lesion Size ◽

Imaging Methods ◽

Malignant Breast ◽

The One ◽

A Prospective Study

Abstract Purpose The aim of the present study was to determine the accuracy of breast cancer measurement with 2 D shear wave elastography (2 D SWE), B-mode ultrasound, and mammography by comparing these methods with the actual histopathological tumor size. Materials and Methods 135 patients with proven malignant breast lesions at two centers were included in a prospective study. The maximum lesion diameter was measured by 2 D SWE, B-mode ultrasound, and mammography. After surgery, the histopathological tumor size was measured by a pathologist. Results The mean difference in tumor size on 2 D SWE, B-mode ultrasound, and mammography on the one hand, and the actual tumor size on the other, was –0.03 cm, 0.16 cm and 0.10 cm, respectively. Lesion size on histopathological investigation was overestimated by 2 D SWE (p = 0.004) and underestimated by B-mode imaging (p < 0.001). All three imaging methods underestimated the size of invasive lobular cancers and lesions > 15 mm; 2 D SWE was most accurate in this regard. Conclusion 2 D SWE predicted lesion size more precisely than B-mode ultrasound or mammography. In cases of invasive lobular carcinoma, all three imaging methods underestimated lesion size, with 2 D SWE coming closest to the actual tumor size.

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A qualitative and quantitative assessment of simultaneous strain, shear wave, and point shear wave elastography to distinguish malignant and benign breast lesions

Acta Radiologica ◽

10.1177/0284185120961422 ◽

2020 ◽

pp. 028418512096142

Author(s):

Yasemin Altıntas ◽

Mehmet Bayrak ◽

Ömer Alabaz ◽

Medih Celiktas

Keyword(s):

Shear Wave ◽

Diagnostic Performance ◽

Area Under The Curve ◽

Shear Wave Elastography ◽

Strain Ratio ◽

Breast Lesions ◽

Breast Masses ◽

Malignant Breast ◽

The Mean ◽

Us Elastography

Background Ultrasound (US) elastography has become a routine instrument in ultrasonographic diagnosis that measures the consistency and stiffness of tissues. Purpose To distinguish benign and malignant breast masses using a single US system by comparing the diagnostic parameters of three kinds of breast elastography simultaneously added to B-mode ultrasonography. Material and Methods A total of 163 breast lesions in 159 consecutive women who underwent US-guided core needle biopsy were included in this prospective study. Before the biopsy, the lesions were examined with B-mode ultrasonography and strain (SE), shear wave (SWE), and point shear wave (STQ) elastography. The strain ratio was computed and the Tsukuba score determined. The mean elasticity values using SWE and STQ were computed and converted to Young’s modulus E (kPa). Results All SE, SWE, and STQ parameters showed similar diagnostic performance. The SE score, SE ratio, SWEmean, SWEmax, STQmean, and STQmax yielded higher specificity than B-mode US alone to differentiate benign and malignant masses. The sensitivity of B-mode US, SWE, and STQ was slightly higher than that of the SE score and SE ratio. The SE score, SE ratio, SWEmean, SWEmax, STQmean, and STQmax had significantly higher positive predictive value and diagnostic accuracy than B-mode US alone. The area under the curve for each of these elastography methods in differentiating benign and malignant breast lesions was 0.93, 0.93, 0.98, 0.97, 0.98, and 0.96, respectively; P<0.001 for all measurements. Conclusion SE (ratio and score), SWE, and STQ had higher diagnostic performance individually than B-mode US alone in distinguishing between malignant and benign breast masses.

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