Pattern classification of ShearWave™ Elastography images for differential diagnosis between benign and malignant solid breast masses.
BACKGROUND
ShearWave™ Elastography (SWE) provides a quantitative measurement of tissue stiffness and may improve characterization of breast masses. However, the significance of Young's modulus measurements and appropriate SWE evaluation criteria has not been established yet.


OBJECTIVE
To assess the usefulness of the pattern classification and Young's modulus measurements in the differential diagnosis between benign and malignant solid breast masses.


METHODS
Ninety-six patients (age range 18-84 years, mean 54 years) with 100 solid breast masses who underwent tissue sampling after a US examination were analyzed. We tried to create a visual pattern classification based on the SWE images. After classifying the visual patterns, the Young's modulus of the lesions was measured in every case.


RESULTS
It was possible to classify the images into four patterns by the visual evaluation: no findings (coded blue homogeneously; Pattern 1), vertical stripe pattern artifacts (Pattern 2), a localized colored area at the margin of the lesion (Pattern 3), and heterogeneously colored areas in the interior of the lesion (Pattern 4). There were 17 Pattern 1 lesions, 14 Pattern 2 lesions, 20 Pattern 3 lesions, and 49 Pattern 4 lesions. When Patterns 1 and 2 were assumed to be benign, and Patterns 3 and 4 were assumed to be malignant, the sensitivity and specificity were 91.3% (63/69) and 80.6% (25/31), respectively. The mean Young's modulus measurements of the benign and the malignant lesions were 42 kPa and 146 kPa, respectively (P < 0.0001). No significant differences were found between benign and malignant lesions in Pattern 3. In Pattern 4, however, the Young's modulus of the benign lesions (50 kPa) was lower than the smallest Young's modulus of malignant lesions (61 kPa).


CONCLUSIONS
The visual pattern classification and adding Young's modulus measurements may improve characterization of solid breast masses.
Division of Breast Imaging, Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan. e-tozaki@keh.biglobe.ne.jp
Mitsuhiro
M
Tozaki
Eisuke
E
Fukuma
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D055815:Young Adult