Shear-wave elastography of the breast: value of a quality measure and comparison with strain elastography.

PURPOSE To determine whether addition of quality measure (QM) of shear-wave (SW) velocity (Vs) estimation can increase SW elastography sensitivity for breast cancer. MATERIALS AND METHODS With written informed consent, this institutional review board-approved, HIPAA-compliant study included 143 women (mean age, 48.5 years ± 8.7) scheduled for breast biopsy. Mean lesion size was 16.4 mm ± 11.8; 95 (66%) lesions were benign; 48 (34%), malignant. If more than one lesion was present, lesion with highest Breast Imaging Reporting and Data System (BI-RADS) category was chosen. If there were more than one with highest BI-RADS category, a lesion was randomly selected. Conventional ultrasonography (US), strain elastography, and SW elastography were performed with QM. QM assesses SW quality to provide accurate Vs. Lesions were evaluated for Vs and QM (high or low). Lesions with Vs of less than 4.5 m/sec were classified benign; lesions with Vs of 4.5 m/sec or greater, malignant. Results were correlated with pathologic findings. Vs data with or without incorporating QM were used to determine SW elastography diagnostic performance. Binomial proportions and exact 95% confidence intervals (CIs) were calculated. RESULTS In 95 benign lesions, 13 (14%) had no SW elastography signal; 77 (81%), Vs of less than 4.5 m/sec; and five (5%), Vs of 4.5 m/sec or greater. In 48 malignant lesions, eight (17%) had no SW elastography signal; 20 (42%), Vs of less than 4.5 m/sec; and 20 (42%), V of 4.5 m/sec or greater. QM was low in 17 of 20 (85%) malignant lesions with Vs of less than 4.5 m/sec. Without QM, using Vs of 4.5 m/sec or greater as test positive, SW elastography had lesion-level sensitivity of 50% (95% CI: 34%, 66%); specificity, 94% (95% CI: 86%, 98%); positive predictive value (PPV), 80% (95% CI: 59%, 93%); and negative predictive value (NPV), 79% (95% CI: 70%, 87%). Using QM where additional lesions with both low Vs and low QM were treated as test positive, SW elastography had lesion-level sensitivity of 93% (95% CI: 80%, 98%); specificity, 89% (95% CI: 80%, 95%); PPV, 80% (95% CI: 66%, 91%); and NPV, 96% (95% CI: 89%, 99%). CONCLUSION Addition of QM can improve SW elastography sensitivity, with no significant change in specificity.

[1]  S. Raza,et al.  Using Real‐time Tissue Elastography for Breast Lesion Evaluation , 2010, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[2]  Alexandru Blidaru,et al.  Added value of Virtual Touch IQ shear wave elastography in the ultrasound assessment of breast lesions. , 2014, European journal of radiology.

[3]  Ying Huang,et al.  A Linear Regression Framework for the Receiver Operating Characteristic (ROC) Curve Analysis. , 2012, Journal of biometrics & biostatistics.

[4]  Mark Palmeri,et al.  Parameters affecting the resolution and accuracy of 2-D quantitative shear wave images , 2012, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

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

[6]  R. Barr,et al.  Sonographic Breast Elastography , 2012, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[7]  Min Bai,et al.  Virtual Touch Tissue Quantification Using Acoustic Radiation Force Impulse Technology , 2012, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[8]  Corinne Balleyguier,et al.  Evaluation of Breast Lesions Using Sonographic Elasticity Imaging , 2012, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[9]  T. Matsumura,et al.  Breast disease: clinical application of US elastography for diagnosis. , 2006, Radiology.

[10]  A. Arieno,et al.  Clinical Experience With Elasticity Imaging in a Community‐Based Breast Center , 2013, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[11]  Sebastian Wojcinski,et al.  Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography. , 2010, Academic radiology.

[12]  G. Trahey,et al.  Shear-wave generation using acoustic radiation force: in vivo and ex vivo results. , 2003, Ultrasound in medicine & biology.

[13]  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.

[14]  Richard G Barr,et al.  Real-Time Ultrasound Elasticity of the Breast: Initial Clinical Results , 2010, Ultrasound quarterly.

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

[16]  Woo Kyung Moon,et al.  Comparison of shear-wave and strain ultrasound elastography in the differentiation of benign and malignant breast lesions. , 2013, AJR. American journal of roentgenology.

[17]  B. Efron.  Bootstrap Methods: Another Look at the Jackknife , 1979 .

[18]  Gregg Trahey,et al.  Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibility. , 2002, Ultrasound in medicine & biology.

[19]  Sachiko Isobe,et al.  Combination of elastography and tissue quantification using the acoustic radiation force impulse (ARFI) technology for differential diagnosis of breast masses , 2012, Japanese Journal of Radiology.

[20]  C. S. Spalding,et al.  In vivo real-time freehand palpation imaging. , 2003, Ultrasound in medicine & biology.

[21]  Amanda E Lackey,et al.  The Utility of the "Bull's-Eye" Artifact on Breast Elasticity Imaging in Reducing Breast Lesion Biopsy Rate , 2011, Ultrasound quarterly.

[22]  Woo Kyung Moon,et al.  Distinguishing benign from malignant masses at breast US: combined US elastography and color doppler US--influence on radiologist accuracy. , 2012, Radiology.

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

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