title: Diagnostic value of commercially available shear-wave elastography for breast cancers: integration into BI-RADS classification with subcategories of category 4.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of shear-wave elastography (SWE) for breast cancer and to determine whether the integration of SWE into BI-RADS with subcategories of category 4 improves the diagnostic performance.
  
  
  METHODS
  A total of 389 breast masses (malignant 120, benign 269) in 324 women who underwent SWE before ultrasound-guided core biopsy or surgery were included. The qualitative SWE feature was assessed using a four-colour overlay pattern. Quantitative elasticity values including the lesion-to-fat elasticity ratio (Eratio) were measured. Diagnostic performance of B-mode ultrasound, SWE, or their combined studies was compared using the area under the ROC curve (AUC).
  
  
  RESULTS
  AUC of Eratio (0.952) was the highest among elasticity values (mean, maximum, and minimum elasticity, 0.949, 0.939, and 0.928; P = 0.04) and AUC of colour pattern was 0.947. AUC of combined studies was significantly higher than for a single study (P < 0.0001). When adding SWE to category 4 lesions, lesions were dichotomised according to % of malignancy: 2.1 % vs. 43.2 % (category 4a) and 0 % vs. 100 % (category 4b) for Eratio and 2.4 % vs. 25.8 % (category 4a) for colour pattern (P < 0.05).
  
  
  CONCLUSIONS
  Shear-wave elastography showed a good diagnostic performance. Adding SWE features to BI-RADS improved the diagnostic performance and may be helpful to stratify category 4 lesions.
  
  
  CONCLUSIONS
  • Quantitative and qualitative shear-wave elastography provides further diagnostic information during breast ultrasound. • The elasticity ratio (E ratio ) showed the best diagnostic performance in SWE. • E ratio and four-colour overlay pattern significantly differed between benign and malignant lesions. • SWE features allowed further stratification of BI-RADS category 4 lesions.
authors: Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-Gu, Seoul, 135-720, South Korea, jhyouk@yuhs.ac.
authors: Ji Hyun
authors: JH
authors: Youk
authors: Hye Mi
authors: HM
authors: Gweon
authors: Eun Ju
authors: EJ
authors: Son
authors: Kyung Hwa
authors: KH
authors: Han
authors: Jeong-Ah
authors: JA
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018511:Systems Integration; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult
references: Eur Radiol. 2012 May;22(5):1023-32
references: 22210408
references: Breast Cancer Res Treat. 2012 Apr;132(3):1089-97
references: 22218886
references: Radiology. 2011 Apr;259(1):59-64
references: 21330569
references: J Ultrasound Med. 2012 Jun;31(6):895-902
references: 22644686
references: Acta Radiol. 2011 Dec 1;52(10):1069-75
references: 22013011
references: Radiology. 2006 May;239(2):385-91
references: 16569780
references: Radiology. 2010 Jul;256(1):297-303
references: 20505064
references: Radiology. 2012 Feb;262(2):435-49
references: 22282182
references: Breast Cancer Res. 2010;12(6):R104
references: 21122101
references: Biometrics. 1988 Sep;44(3):837-45
references: 3203132
references: AJR Am J Roentgenol. 2005 Apr;184(4):1260-5
references: 15788607
references: Breast Cancer Res Treat. 2011 Aug;129(1):89-97
references: 21681447
references: IEEE Trans Ultrason Ferroelectr Freq Control. 2004 Apr;51(4):396-409
references: 15139541
references: J Ultrasound Med. 2012 May;31(5):773-83
references: 22535725
references: Radiology. 2008 Sep;248(3):773-81
references: 18647850
references: AJR Am J Roentgenol. 2008 May;190(5):1209-15
references: 18430833
references: AJR Am J Roentgenol. 2012 Jun;198(6):W624-5; author reply W626
references: 22623583
references: Br J Cancer. 2012 Jul 10;107(2):224-9
references: 22691969