Diagnostic features of quantitative comb-push shear elastography for breast lesion differentiation

Background Lesion stiffness measured by shear wave elastography has shown to effectively separate benign from malignant breast masses. The aim of this study was to evaluate different aspects of Comb-push Ultrasound Shear Elastography (CUSE) performance in differentiating breast masses. Methods With written signed informed consent, this HIPAA- compliant, IRB approved prospective study included patients from April 2014 through August 2016 with breast masses identified on conventional imaging. Data from 223 patients (19–85 years, mean 59.93±14.96 years) with 227 suspicious breast masses identifiable by ultrasound (mean size 1.83±2.45cm) were analyzed. CUSE was performed on all patients. Three regions of interest (ROI), 3 mm in diameter each, were selected inside the lesion on the B-mode ultrasound which also appeared in the corresponding shear wave map. Lesion elasticity values were measured in terms of the Young’s modulus. In correlation to pathology results, statistical analyses were performed. Results Pathology revealed 108 lesions as malignant and 115 lesions as benign. Additionally, 4 lesions (BI-RADS 2 and 3) were considered benign and were not biopsied. Average lesion stiffness measured by CUSE resulted in 84.26% sensitivity (91 of 108), 89.92% specificity (107 of 119), 85.6% positive predictive value, 89% negative predictive value and 0.91 area under the curve (P<0.0001). Stiffness maps showed spatial continuity such that maximum and average elasticity did not have significantly different results (P > 0.21). Conclusion CUSE was able to distinguish between benign and malignant breast masses with high sensitivity and specificity. Continuity of stiffness maps allowed for choosing multiple quantification ROIs which covered large areas of lesions and resulted in similar diagnostic performance based on average and maximum elasticity. The overall results of this study, highlights the clinical value of CUSE in differentiation of breast masses based on their stiffness.

[1]  M. Fatemi,et al.  Effect of Calcifications on Breast Ultrasound Shear Wave Elastography: An Investigational Study , 2015, PloS one.

[2]  Gregg E. Trahey,et al.  Acoustic radiation force impulse imaging: ex vivo and in vivo demonstration of transient shear wave propagation , 2002, Proceedings IEEE International Symposium on Biomedical Imaging.

[3]  M. Fink,et al.  Supersonic shear imaging: a new technique for soft tissue elasticity mapping , 2004, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[4]  Mostafa Fatemi,et al.  An experimental phantom study on the effect of calcifications on ultrasound shear wave elastography , 2015, 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[5]  A. Thompson,et al.  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 , 2012, British Journal of Cancer.

[6]  Jason P Fine,et al.  Differentiating Benign from Malignant Solid Breast Masses with US Strain Imaging 1 , 2007 .

[7]  Armando Manduca,et al.  Comb-Push Ultrasound Shear Elastography (CUSE): A Novel Method for Two-Dimensional Shear Elasticity Imaging of Soft Tissues , 2012, IEEE Transactions on Medical Imaging.

[8]  Hui-Xiong Xu,et al.  Diagnostic Value of Virtual Touch Tissue Quantification for Breast Lesions with Different Size , 2014, BioMed research international.

[9]  Michelle L. Robbin,et al.  AIUM Practice Guideline for the Performance of a Breast Ultrasound Examination , 2009, Journal of Ultrasound in Medicine.

[10]  Markus Hahn,et al.  Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review , 2009, BMC Cancer.

[11]  T. M. Kolb,et al.  Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. , 2002, Radiology.

[12]  Pengfei Song,et al.  Update on breast cancer detection using comb-push ultrasound shear elastography , 2015, IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control.

[13]  Pengfei Song,et al.  Comb-Push Ultrasound Shear Elastography of Breast Masses: Initial Results Show Promise , 2015, PloS one.

[14]  S. Emelianov,et al.  Shear wave elasticity imaging: a new ultrasonic technology of medical diagnostics. , 1998, Ultrasound in medicine & biology.

[15]  Kim Thomson,et al.  Quantitative shear wave ultrasound elastography: initial experience in solid breast masses , 2010, Breast Cancer Research.

[16]  Richard G Barr,et al.  Shear-wave elastography of the breast: value of a quality measure and comparison with strain elastography. , 2015, Radiology.

[17]  Li Ying,et al.  Performance of Shear Wave Elastography for Differentiation of Benign and Malignant Solid Breast Masses , 2013, PloS one.

[18]  R. Pathmanathan,et al.  Diabetic Mastopathy: A Case Report and Literature Review , 2010, Case Reports in Oncology.

[19]  Heng Zhao,et al.  Two-dimensional shear-wave elastography on conventional ultrasound scanners with time-aligned sequential tracking (TAST) and comb-push ultrasound shear elastography (CUSE) , 2015, IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control.

[20]  M. Fink,et al.  Breast lesions: quantitative elastography with supersonic shear imaging--preliminary results. , 2010, Radiology.

[21]  David O. Cosgrove,et al.  Shear wave elastography for breast masses is highly reproducible , 2011, European Radiology.

[22]  A. Thompson,et al.  Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. , 2012, Radiology.

[23]  Richard G Barr,et al.  Shear Wave Imaging of the Breast , 2012, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[24]  Rebecca S Lewis,et al.  Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. , 2004, Radiology.

[25]  Jean B. Cormack,et al.  Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. , 2008, JAMA.

[26]  Hui-Xiong Xu,et al.  A novel two-dimensional quantitative shear wave elastography for differentiating malignant from benign breast lesions. , 2015, International journal of clinical and experimental medicine.

[27]  Cai Chang,et al.  Breast lesions: evaluation with shear wave elastography, with special emphasis on the "stiff rim" sign. , 2014, Radiology.

[28]  James F. Greenleaf,et al.  Comb-Push Ultrasound Shear Elastography (CUSE) for Evaluation of Thyroid Nodules: Preliminary In Vivo Results , 2015, IEEE Transactions on Medical Imaging.

[29]  M Heller,et al.  Breast ultrasound elastography--results of 193 breast lesions in a prospective study with histopathologic correlation. , 2011, European journal of radiology.

[30]  W. Svensson,et al.  Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. , 2012, Radiology.

[31]  C. Sewell,et al.  Pathology of benign and malignant breast disorders. , 1995, Radiologic clinics of North America.