title: Diagnostic value of elastography using acoustic radiation force impulse imaging and strain ratio for breast tumors.
abstract: OBJECTIVE
  The aim of this study was to determine whether the combination of B-mode ultrasonography (BUS), acoustic radiation force impulse (ARFI) elastography, and strain ratio (SR) provides better diagnostic performance of breast lesion differentiation than BUS alone.
  
  
  METHODS
  ARFI elastography and SR evaluations were performed on patients with 157 breast lesions diagnosed by BUS from June to September 2013. BUS images were classified according to the Breast Imaging-Reporting and Data System. ARFI elastography was performed using Virtual Touch™ tissue imaging (VTI) and Virtual Touch™ tissue quantification (VTQ). In VTI mode, we evaluated the color-mapped patterns of the breast lesion and surrounding tissue. The lesions were classified into five categories by elasticity score. In VTQ mode, each lesion was assessed using shear wave velocity (SWV) measurements. SR was calculated from the lesion and comparable lateral fatty tissue. We compared the diagnostic performance of BUS alone and the combination of BUS, ARFI elastography, and SR evaluations.
  
  
  RESULTS
  Among the 157 lesions, 40 were malignant and 117 were benign. The mean elasticity score (3.7±1.0 vs. 1.6±0.8, p<0.01), SWV (4.23±1.09 m/sec vs. 2.22±0.88 m/sec, p<0.01), and SR (5.69±1.63 vs. 2.69±1.40, p<0.01) were significantly higher for malignant lesions than benign lesions. The results for BUS combined with ARFI elastography and SR values were 97.5% sensitivity, 92.3% specificity, 93.6% accuracy, a 79.6% positive predictive value (PPV), and a 99.1% negative predictive value. The combination of the 3 radiologic examinations yielded superior specificity, accuracy, and PPV compared to BUS alone (p<0.01 for each).
  
  
  CONCLUSIONS
  ARFI elastography and SR evaluations showed significantly different mean values for benign and malignant lesions. Moreover, these two modalities complemented BUS and improved the diagnostic performance of breast lesion detection. Therefore, ARFI elastography and SR evaluations can be used as complementary modalities to make more accurate breast lesion diagnoses.
authors.affiliation: Department of Surgery, Kosin University Gospel Hospital, Busan, Korea.
authors.forename: Yoon Seok
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiology, Kosin University Gospel Hospital, Busan, Korea.
authors.forename: Jung Gu
authors.initials: JG
authors.lastname: Park
authors.affiliation: Department of Radiology, Kosin University Gospel Hospital, Busan, Korea.
authors.forename: Beom Su
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Surgery, Kosin University Gospel Hospital, Busan, Korea.
authors.forename: Chung Han
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Kosin University Gospel Hospital, Busan, Korea.
authors.forename: Dong Won
authors.initials: DW
authors.lastname: Ryu
keywords: Breast neoplasms; Elasticity imaging techniques; Ultrasonography
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