title: Quantitative evaluation of peripheral tissue elasticity for ultrasound-detected breast lesions.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of the quantitative measurement of peripheral tissue elasticity using shear-wave elastography (SWE) in differentiating between benign and malignant breast lesions detected by ultrasonography (US).
  
  
  METHODS
  This study was approved by institutional review board; informed consent was signed from all patients. From June 2012 to April 2014, conventional B-mode US and SWE were performed in 205 breast lesions (78 malignant, 127 benign) of 205 consecutive women (mean age, 41.9±12.3 years; age range, 18-76 years). For each lesion, a rim around its contour was constructed by using a computer-aided tool, including adequate adjacent peripheral tissue. Quantitative elastographic features of the rim (elasticity mean, maximum, standard deviation, and elasticity ratio) as well as Breast Imaging Reporting and Data System (BI-RADS) categories were assessed according to the final histopathological results. Sensitivity, specificity, positive and negative predictive values, and receiver operating characteristic (ROC) curve analysis were performed to evaluate the diagnostic performances for the three data sets (conventional B-mode US alone, SWE features alone, and combined B-mode US and SWE features).
  
  
  RESULTS
  SWE features of the peripheral tissue differed significantly between benign and malignant breast lesions (mean±standard deviation [SD]: elasticity mean, 16.1±6.6 versus 43.6±17.8; maximum, 55.4±31.4 versus 150.3±44.6; SD, 8.1±4.1 versus 30±13.8 and elasticity ratio, 1.1±0.2 versus 2±0.7, respectively, all p<0.001), and enabled significantly higher specificities compared with conventional B-mode US alone (92.9%, 84.3%, 94.5%, and 93.7% versus 44.1%, respectively, all p<0.001). The combinations of SWE assessment (including individual features and the logistic regression model of all four features) and conventional B-mode US for BI-RADS 3 and 4a lesions significantly improved the diagnostic performance compared with B-mode US alone, with significantly increased specificity (85%, 82.7%, 81.9%, 86.6%, and 85% versus 44.1%; all p<0.001) and AUC (0.942, 0.940, 0.940, 0.935, and 0.953 versus 0.916, all p<0.05).
  
  
  CONCLUSIONS
  Quantitative evaluation of the elastic properties of the peripheral tissue exhibited good discriminatory ability in differentiating US-detected breast lesions and could be used to further stratify low-suspicion lesions within BI-RADS category 3 and 4a to avoid unnecessary biopsy.
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Department of Department of Electronic Engineering, City University of Hong Kong, Hong Kong, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: L
authors.initials: L
authors.lastname: Niu
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: M
authors.initials: M
authors.lastname: Qian
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Deng
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
authors.forename: W
authors.initials: W
authors.lastname: Qiu
authors.affiliation: Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China. Electronic address: hr.zheng@siat.ac.cn.
authors.forename: H
authors.initials: H
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult