title: A new qualitative pattern classification of shear wave elastograghy for solid breast mass evaluation.
abstract: OBJECTIVE
  To examine the efficacy of qualitative shear wave elastography (SWE) in the classification and evaluation of solid breast masses, and to compare this method with conventional ultrasonograghy (US), quantitative SWE parameters and qualitative SWE classification proposed before.
  
  
  METHODS
  From April 2015 to March 2016, 314 consecutive females with 325 breast masses who decided to undergo core needle biopsy and/or surgical biopsy were enrolled. Conventional US and SWE were previously performed in all enrolled subjects. Each mass was classified by two different qualitative classifications. One was established in our study, herein named the Qual1. Qual1 could classify the SWE images into five color patterns by the visual evaluations: Color pattern 1 (homogeneous pattern); Color pattern 2 (comparative homogeneous pattern); Color pattern 3 (irregularly heterogeneous pattern); Color pattern 4 (intralesional echo pattern); and Color pattern 5 (the stiff rim sign pattern). The second qualitative classification was named Qual2 here, and included a four-color overlay pattern classification (Tozaki and Fukuma, Acta Radiologica, 2011). The Breast Imaging Reporting and Data System (BI-RADS) assessment and quantitative SWE parameters were recorded. Diagnostic performances of conventional US, SWE parameters, and combinations of US and SWE parameters were compared.
  
  
  RESULTS
  With pathological results as the gold standard, of the 325 examined breast masses, 139 (42.77%) samples were malignant and 186 (57.23%) were benign. The Qual1 showed a higher Az value than the Qual2 and quantitative SWE parameters (all P<0.05). When applying Qual1=Color pattern 1 for downgrading and Qual1=Color pattern 5 for upgrading the BI-RADS categories, we obtained the highest Az value (0.951), and achieved a significantly higher specificity (86.56%, P=0.002) than that of the US (81.18%) with the same sensitivity (94.96%).
  
  
  CONCLUSIONS
  The qualitative classification proposed in this study may be representative of SWE parameters and has potential to be relevant assistance in breast mass diagnoses.
authors.affiliation: Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, 110004, China. Electronic address: congrui2684@163.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Cong
authors.affiliation: Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, 110004, China. Electronic address: lijing@sj-hospital.org.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, 110004, China. Electronic address: 21751735@qq.com.
authors.forename: Song
authors.initials: S
authors.lastname: Guo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult
keywords: Breast; Diagnosis; Imaging techniques; Shear wave elastography; Ultrasound