Role of shear-wave elastography (SWE) in complex cystic and solid breast lesions in comparison with conventional ultrasound.
OBJECTIVE
To evaluate the additional role of shear-wave elastography (SWE) in differential diagnosis of complex cystic and solid breast lesions.


METHODS
From January 2013 to November 2013, 140 complex cystic and solid breast lesions from 139 consecutive patients were performed ultrasound and SWE prior to biopsy. BI-RADS ultrasound final assessment and SWE parameters were recorded for each lesion. Histopathologic diagnosis was used as the reference standard.


RESULTS
Among the 140 lesions, 30 lesions (21.4%) were malignant. The mean maximum elasticity (Emax) of malignant lesions (184.3 kPa) was significantly higher than that of benign lesions (45.5 kPa) (P<0.001). Homogeneity of elasticity and color pattern were significantly different from malignancy and benign lesions (P<0.05). Emax with cutoff value at 108.5 kPa showed Az value of 0.968 (95% CI, 0.932-0.985) with sensitivity of 86.7% and specificity of 97.3%. Using this cutoff value, false-positive rate was 2.7% and false-negative rate was 13.3%. By applying an Emax value of 108.5 kPa or less as a criterion for downgrading BI-RADS category 4a lesions to category 3 lesions, 103/123 (83.7%) lesions could be downgraded to category 3 lesions.


CONCLUSIONS
Additional use of SWE could reduce unnecessary benign biopsies in complex cystic and solid breast lesions.
Department of Radiology, Ewha Womans University, School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea.
Bo Eun
BE
Lee
Department of Radiology, Ewha Womans University, School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea. Electronic address: aqua0724@ewha.ac.kr.
Jin
J
Chung
Department of Radiology, Ewha Womans University, School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea.
Eun-Suk
ES
Cha
Department of Radiology, Ewha Womans University, School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea.
Jee Eun
JE
Lee
Department of Radiology, Ewha Womans University, School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea.
Jeoung Hyun
JH
Kim
D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods
Breast; Cystic lesion; Elastography; Shear-wave; Ultrasound