Differentiation of benign and malignant breast lesions using shear wave elastography; estimation of the most accurate parameters

Authors

  • Natalia Andryszak Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
  • Antonina Godlewska Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
  • Anna Pasiuk-Czepczyńska Cancer Prevention and Epidemiology Center, Poznań, Poland
  • Dariusz Godlewski Cancer Prevention and Epidemiology Center, Poznań, Poland
  • Marek Ruchała Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
  • Rafał Czepczyński Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland

DOI:

https://doi.org/10.20883/medical.e1224

Keywords:

breast cancer, ultrasound, SWE, breast imaging

Abstract

Objectives: Breast elastography is a sonographic imaging technique, used additionally in diagnosis of breast lesions. The place of shear-wave elastography (SWE) in breast imaging is still unclear, the literature is limited and the interpretation of SWE results is undefined. The aim of our study was to evaluate the diagnostic accuracy of SWE in relation to histopathology and to estimate the probable cut-off value of SWE parameters, which would indicate malignancy.

Material and Methods: The study included 53 consecutive patients with suspicious breast lesions. Each patient underwent the SWE of the breasts, and every visualized lesion was biopsied.

Results: 56 lesions were found; 24 of them were classified as malignant and then confirmed as cancer. Malignant tumours presented with significantly higher SWE parameters, except Efat, as compared to benign lesions. The ROC curve analysis established cut-off values of: Emax 63.4 kPa (p<0,000001, AUC 0.94), Emean of 40.8 kPa (p=0.000003, AUC 0.87), Emax/Efat ratio of 5.64 kPa (p<0.000001, AUC 0.92) and Emean/Efat ratio of 4.31 kPa, (p=0.000006, AUC 0.86), which indicate malignancy. There were no differences in SWE parameters between cancer subtypes.

Conclusion: In our study SWE indicated correctly all malignant lesions. Moreover, we established cut-off values of SWE parameters that may be useful in differentiating malignant and benign breast lesions.

Downloads

Download data is not yet available.

References

1. Shiina T, Nightingale KR, Palmeri ML, Hall TJ, Bamber JC, Barr RG, Castera L, Choi BI, Chou YH, Cosgrove D, Dietrich CF, Ding H, Amy D, Farrokh A, Ferraioli G, Filice C, Friedrich-Rust M, Nakashima K, Schafer F, Sporea I, Suzuki S, Wilson S, Kudo M. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015 May;41(5):1126-47. doi: 10.1016/j.ultrasmedbio.2015.03.009. Epub 2015 Mar 21. PMID: 25805059.

2. Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound Elastography: Review of Techniques and Clinical Applications. Theranostics. 2017 Mar 7;7(5):1303-1329. doi: 10.7150/thno.18650. PMID: 28435467; PMCID: PMC5399595.

3. Park SY, Kang BJ. Combination of shear-wave elastography with ultrasonography for detection of breast cancer and reduction of unnecessary biopsies: a systematic review and meta-analysis. Ultrasonography. 2021;40(3):318-332. doi:10.14366/usg.20058

4. Lee EJ, Chang YW. Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses. Korean J Radiol. 2020;21(9):1045-1054. doi:10.3348/kjr.2019.0765

5. Liu B, Zheng Y, Huang G, Lin M, Shan Q, Lu Y, Tian W, Xie X. Breast Lesions: Quantitative Diagnosis Using Ultrasound Shear Wave Elastography-A Systematic Review and Meta-Analysis. Ultrasound Med Biol. 2016 Apr;42(4):835-47. doi: 10.1016/j.ultrasmedbio.2015.10.024. Epub 2016 Jan 6. PMID: 26778289.

6. Tian J, Liu Q, Wang X, Xing P, Yang Z, Wu C. Application of 3D and 2D quantitative shear wave elastography (SWE) to differentiate between benign and malignant breast masses. Sci Rep. 2017;7:41216. Published 2017 Jan 20. doi:10.1038/srep41216

7. Cosgrove DO, Berg WA, Doré CJ, Skyba, D. M., Henry, J. P., Gay, J., Cohen-Bacrie C, Shear wave elastography for breast masses is highly reproducible. Eur Radiol. 2012;22(5):1023-1032. doi:10.1007/s00330-011-2340-y

8. Hong S, Woo OH, Shin HS, Hwang SY, Cho KR, Seo BK. Reproducibility and diagnostic performance of shear wave elastography in evaluating breast solid mass. Clin Imaging. 2017;44:42-45. doi:10.1016/j.clinimag.2017.03.022

9. Cardoso F, Kyriakides S, Ohno S, Penault-Llorca F, Poortmans P, Rubio IT, Zackrisson S, Senkus E; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019 Aug 1;30(8):1194-1220. doi: 10.1093/annonc/mdz173. Erratum in: Ann Oncol. 2019 Oct 1;30(10):1674. Erratum in: Ann Oncol. 2021 Feb;32(2):284. PMID: 31161190.

10. European guidelines on breast cancer screening and diagnosis by The European Commission Initiative on Breast Cancer (ECIBC) https://healthcare-quality.jrc.ec.europa.eu/ecibc/european-breast-cancer-guidelines

11. Kumaraswamy V, Carder PJ. Examination of breast needle core biopsy specimens performed for screen-detected microcalcification. J Clin Pathol. 2007;60(6):681-684. doi:10.1136/jcp.2006.038190

12. Song EJ, Sohn YM, Seo M. Diagnostic performances of shear-wave elastography and B-mode ultrasound to differentiate benign and malignant breast lesions: the emphasis on the cutoff value of qualitative and quantitative parameters. Clin Imaging. 2018;50:302-307. doi:10.1016/j.clinimag.2018.05.007

13. Au FW, Ghai S, Moshonov H, Kahn H, Brennan C, Dua H, Crystal P. Diagnostic performance of quantitative shear wave elastography in the evaluation of solid breast masses: determination of the most discriminatory parameter. AJR Am J Roentgenol. 2014 Sep;203(3):W328-36. doi: 10.2214/AJR.13.11693. PMID: 25148191.

14. Kim H, Lee J, Kang BJ, Kim SH. What shear wave elastography parameter best differentiates breast cancer and predicts its histologic aggressiveness?. Ultrasonography. 2021;40(2):265-273. doi:10.14366/usg.20007

15. Chang JM, Park IA, Lee SH, Kim WH, Bae MS, Koo HR, Yi A, Kim SJ, Cho N, Moon WK. Stiffness of tumours measured by shear-wave elastography correlated with subtypes of breast cancer. Eur Radiol. 2013 Sep;23(9):2450-8. doi: 10.1007/s00330-013-2866-2. Epub 2013 May 15. PMID: 23673574.

16. Suvannarerg V, Chitchumnong P, Apiwat W, Lertdamrongdej L, Tretipwanit N, Pisarnturakit P, Sitthinamsuwan P, Thiravit S, Muangsomboon K, Korpraphong P. Diagnostic performance of qualitative and quantitative shear wave elastography in differentiating malignant from benign breast masses, and association with the histological prognostic factors. Quant Imaging Med Surg. 2019 Mar;9(3):386-398. doi: 10.21037/qims.2019.03.04. PMID: 31032186; PMCID: PMC6462575.

17. Luo C, Lu L, Zhang W, Li X, Zhou P, Ran Z. The Value of Shear Wave Elastography in the Diagnosis of Breast Cancer Axillary Lymph Node Metastasis and Its Correlation With Molecular Classification of Breast Masses. Front Oncol. 2022;12:846568. Published 2022 Mar 17. doi:10.3389/fonc.2022.846568

18. Gemici AA, Ozal ST, Hocaoglu E, Inci E. Relationship Between Shear Wave Elastography Findings and Histologic Prognostic Factors of Invasive Breast Cancer. Ultrasound Q. 2020;36(1):79-83. doi:10.1097/RUQ.0000000000000471

19. Youk JH, Gweon HM, Son EJ. Shear-wave elastography in breast ultrasonography: the state of the art. Ultrasonography. 2017;36(4):300-309. doi:10.14366/usg.17024

20. Choi HY, Seo M, Sohn YM, Hwang JH, Song EJ, Min SY, Kang HJ, Han DY. Shear wave elastography for the diagnosis of small (≤2 cm) breast lesions: added value and factors associated with false results. Br J Radiol. 2019 May;92(1097):20180341. doi: 10.1259/bjr.20180341. Epub 2019 Mar 26. PMID: 30817169; PMCID: PMC6580903.

21. Barr RG. Future of breast elastography. Ultrasonography. 2019 Apr;38(2):93-105. doi: 10.14366/usg.18053. Epub 2019 Jan 4. PMID: 30884636; PMCID: PMC6443587.

22. Stavros AT, Rapp CL, Parker SH. Breast Ultrasound / A. Thomas Stavros ; with Contributions by Cynthia L. Rapp, Steve H. Parker. Lippincott Williams & Wilkins; 2004.

23. Feldmann A, Langlois C, Dewailly M, Martinez EF, Boulanger L, Kerdraon O, Faye N. Shear Wave Elastography (SWE): An Analysis of Breast Lesion Characterization in 83 Breast Lesions. Ultrasound Med Biol. 2015 Oct;41(10):2594-604. doi: 10.1016/j.ultrasmedbio.2015.05.019. Epub 2015 Jul 7. PMID: 26159068.

24. Berg WA, Blume JD, Cormack JB, Mendelson EB, et al.; ACRIN 6666 Investigators. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008 May 14;299(18):2151-63. doi: 10.1001/jama.299.18.2151. Erratum in: JAMA. 2010 Apr 21;303(15):1482. PMID: 18477782; PMCID: PMC2718688.

25. Berg WA, Cosgrove DO, Doré CJ, Schäfer FK, Svensson WE, Hooley RJ, Ohlinger R, Mendelson EB, Balu-Maestro C, Locatelli M, Tourasse C, Cavanaugh BC, Juhan V, Stavros AT, Tardivon A, Gay J, Henry JP, Cohen-Bacrie C; BE1 Inves-tigators. Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Ra-diology. 2012 Feb;262(2):435-49. doi: 10.1148/radiol.11110640. PMID: 22282182.

26. Gweon HM, Youk JH, Son EJ, Kim JA. Visually assessed colour overlay features in shear-wave elastography for breast masses: Quantification and diagnostic performance. Eur Radiol 2013;23:658–663.

27. Evans, A., Whelehan, P., Thomson, K. et al. Differentiating benign from malignant solid breast masses: the value of shear wave elastography according to lesion stiffness combined with greyscale ultrasound according to BI-RADS classification. Br J Cancer 107, 224–229 (2012). https://doi.org/10.1038/bjc.2012.253

28. Chang JM, Moon WK, Cho N, Yi A, Koo H, Han W, Noh D, Moon H, Kim S (2011) Clinical application of shearwave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat 129: 89–97

29. Jiang H, Yu X, Zhang L, Song L, Gao X. Diagnostic values of shear wave elastography and strain elastography for breast lesions. Rev Med Chil. 2020 Sep;148(9):1239-1245. doi: 10.4067/S0034-98872020000901239. PMID: 33399698.

30. Bae JS, Chang JM, Lee SH, Shin SU, Moon WK. Prediction of invasive breast cancer using shear-wave elastography in patients with biopsy-confirmed ductal carcinoma in situ. Eur Radiol. 2017 Jan;27(1):7-15. doi: 10.1007/s00330-016-4359-6. Epub 2016 Apr 16. PMID: 27085697.

31. World Health Organisation (2006) Guidelines for the early detection and screening of breast cancer. EMRO Technical Publications Series

32. Mann RM, Athanasiou A, Baltzer PAT, et al. European Society of Breast Imaging (EUSOBI). Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radi-ol. 2022 Jun;32(6):4036-4045. doi: 10.1007/s00330-022-08617-6. Epub 2022 Mar 8. PMID: 35258677; PMCID: PMC9122856.

Published

2025-07-01

Issue

Section

Original Papers

How to Cite

1.
Differentiation of benign and malignant breast lesions using shear wave elastography; estimation of the most accurate parameters. JMS [Internet]. 2025 Jul. 1 [cited 2025 Jul. 6];94(2):e1224. Available from: https://jmsnew.ump.edu.pl/index.php/JMS/article/view/1224