Simultaneous comparison between strain and shear wave elastography of breast masses for the differentiation of benign and malignant lesions by qualitative and quantitative assessments

PurposeTo compare the addition of diagnostic strain elastography (SE) and shear wave elastography (SWE) values to the conventional B-mode ultrasonography in differentiating between benign and malignant breast masses by qualitative and quantitative assessments.Materials and methodsB-mode ultrasound, SE, and SWE were simultaneously performed using one ultrasound system in 148 breast masses; 88 of them were malignant. The breast imaging reporting and data system category in the B-mode, Tsukuba score (SETsu), Fat-Lesion-Ratio (SEFLR) in SE, and five-point color assessment (SWEcol) and elasticity values (SWEela) in SWE were assessed. The results were compared using the area under the receiver-operating characteristic curve (AUC).ResultThe AUC for B-mode and each elastography were similar (B-mode, 0.889; SETsu, 0.885; SEFLR, 0.875; SWEcol, 0.881; SWEela, 0.885; P > 0.05). The combined sets between B-mode and either of the elastography technique showed good diagnostic performance (B-mode + SETsu, 0.903; B-mode + SEFLR, 0.909; B-mode + SWEcol, 0.919; B-mode + SWEela, 0.914). B-mode + SWEcol and B-mode + SWEela showed a higher AUC than B-mode alone (P = 0.026 and 0.029), and B-mode + SETsu and B-mode + SEFLR showed comparable AUC to B-mode alone (P = 0.196 and 0.085). There was no significant difference between qualitative and quantitative assessments for the combined sets of B-mode and elastography (P > 0.05).ConclusionThe addition of both SE and SWE to B-mode ultrasound improved the diagnostic performance with increased AUC, and especially SWE was more useful than SE, and no significant difference was found between qualitative and quantitative assessments.