title: Influence of region of interest size and ultrasound lesion size on the performance of 2D shear wave elastography (SWE) in solid breast masses.
abstract: OBJECTIVE
  To evaluate the influence of the region of interest (ROI) size and lesion diameter on the diagnostic performance of 2D shear wave elastography (SWE) of solid breast lesions.
  
  
  METHODS
  A study group of 206 consecutive patients (age range 21-92 years) with 210 solid breast lesions (70 benign, 140 malignant) who underwent core biopsy or surgical excision was evaluated. Lesions were divided into small (diameter <15 mm, n=112) and large lesions (diameter ≥15 mm, n=98). An ROI with a diameter of 1, 2, and 3 mm was positioned over the stiffest part of the lesion. The maximum elasticity (Emax), mean elasticity (Emean) and standard deviation (SD) for each ROI size were compared to the pathological outcome. Statistical analysis was undertaken using the chi-square test and receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  The ROI size used has a significant impact on the performance of Emean and SD but not on Emax. Youden's indices show a correlation with the ROI size and lesion size: generally, the benign/malignant threshold is lower with increasing ROI size but higher with increasing lesion size.
  
  
  CONCLUSIONS
  No single SWE parameter has superior performance. Lesion size and ROI size influence diagnostic performance.
authors.affiliation: Medical Research Institute, Ninewells Hospital & Medical School, Mailbox 4, Dundee DD1 9SY, UK. Electronic address: k.skerl@dundee.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: Skerl
authors.affiliation: Medical Research Institute, Ninewells Hospital & Medical School, Mailbox 4, Dundee DD1 9SY, UK.
authors.forename: S
authors.initials: S
authors.lastname: Vinnicombe
authors.affiliation: Medical Research Institute, Ninewells Hospital & Medical School, Mailbox 4, Dundee DD1 9SY, UK; Department of Biomedical Sciences, Experimental and Clinical "Mario Serio" University of Florence, Viale Morgagni 50, 50134 Firenze (FI), Italy.
authors.forename: E
authors.initials: E
authors.lastname: Giannotti
authors.affiliation: Medical Research Institute, Ninewells Hospital & Medical School, Mailbox 4, Dundee DD1 9SY, UK.
authors.forename: K
authors.initials: K
authors.lastname: Thomson
authors.affiliation: Medical Research Institute, Ninewells Hospital & Medical School, Mailbox 4, Dundee DD1 9SY, UK.
authors.forename: A
authors.initials: A
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001940:Breast / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D005260:Female; D006801:Humans; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary; D055815:Young Adult