Performance of shear-wave elastography for breast masses using different region-of-interest (ROI) settings

Abstract

Background

Various size and shape of region of interest (ROI) can be applied for shear-wave elastography (SWE).

Purpose

To investigate the diagnostic performance of SWE according to ROI settings for breast masses.

Material and Methods

To measure elasticity for 142 lesions, ROIs were set as follows: circular ROIs 1 mm (ROI-1), 2 mm (ROI-2), and 3 mm (ROI-3) in diameter placed over the stiffest part of the mass; freehand ROIs drawn by tracing the border of mass (ROI-M) and the area of peritumoral increased stiffness (ROI-MR); and circular ROIs placed within the mass (ROI-C) and to encompass the area of peritumoral increased stiffness (ROI-CR). Mean (E_mean), maximum (E_max), and standard deviation (E_SD) of elasticity values and their areas under the receiver operating characteristic (ROC) curve (AUCs) for diagnostic performance were compared.

Results

Means of E_mean and E_SD significantly differed between ROI-1, ROI-2, and ROI-3 (P < 0.0001), whereas means of E_max did not (P = 0.50). For E_SD, ROI-1 (0.874) showed a lower AUC than ROI-2 (0.964) and ROI-3 (0.975) (P < 0.002). The mean E_SD was significantly different between ROI-M and ROI-MR and between ROI-C and ROI-CR (P < 0.0001). The AUCs of E_SD in ROI-M and ROI-C were significantly lower than in ROI-MR (P = 0.041 and 0.015) and ROI-CR (P = 0.007 and 0.004).

Conclusion

Shear-wave elasticity values and their diagnostic performance vary based on ROI settings and elasticity indices. E_max is recommended for the ROIs over the stiffest part of mass and an ROI encompassing the peritumoral area of increased stiffness is recommended for elastic heterogeneity of mass.

Keywords

Breast cancer ultrasonography sonoelastography shear wave diagnostic performance

Get full access to this article

View all access options for this article.

References

Lee

Chang

Cho

et al.

Practice guideline for the performance of breast ultrasound elastography. Ultrasonography 2014; 33: 3–10.

Barr

. Sonographic breast elastography: a primer. J Ultrasound Med 2012; 31: 773–783.

Youk

Son

Park

et al.

Shear-wave elastography for breast masses: local shear wave speed (m/sec) versus Young modulus (kPa). Ultrasonography 2014; 33: 34–39.

Athanasiou

Tardivon

Tanter

et al.

Breast lesions: quantitative elastography with supersonic shear imaging–preliminary results. Radiology 2010; 256: 297–303.

Berg

Cosgrove

Dore

et al.

Shear-wave elastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology 2012; 262: 435–449.

Evans

Whelehan

Thomson

et al.

Differentiating benign from malignant solid breast masses: value of shear wave elastography according to lesion stiffness combined with greyscale ultrasound according to BI-RADS classification. Br J Cancer 2012; 107: 224–229.

Youk

Gweon

Son

et al.

Diagnostic value of commercially available shear-wave elastography for breast cancers: integration into BI-RADS classification with subcategories of category 4. Eur Radiol 2013; 23: 2695–2704.

Youk

Son

Gweon

et al.

Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B-mode ultrasonography: qualitative and quantitative assessments. Ultrasound Med Biol 2014; 40: 2336–2344.

Fang

et al.

Performance of shear wave elastography for differentiation of benign and malignant solid breast masses. PLoS One 2013; 8: e76322–e76322.

10.

Liu

Zheng

Huang

et al.

Breast lesions: quantitative diagnosis using ultrasound shear wave elastography-a systematic review and meta–analysis. Ultrasound Med Biol 2016; 42: 835–847.

11.

Skerl

Vinnicombe

Giannotti

et al.

Influence of region of interest size and ultrasound lesion size on the performance of 2D shear wave elastography (SWE) in solid breast masses. Clin Radiol 2015; 70: 1421–1427.

12.

Gweon

Youk

Son

et al.

Visually assessed colour overlay features in shear-wave elastography for breast masses: quantification and diagnostic performance. Eur Radiol 2013; 23: 658–663.

13.

Wang

et al.

Study of quantitative elastography with supersonic shear imaging in the diagnosis of breast tumours. Radiol Med 2013; 118: 583–590.

14.

Zhou

Zhan

Chang

et al.

Breast lesions: evaluation with shear wave elastography, with special emphasis on the “stiff rim” sign. Radiology 2014; 272: 63–72.

15.

Shi

Wan

et al.

A set of shear wave elastography quantitative parameters combined with ultrasound BI-RADS to assess benign and malignant breast lesions. Ultrasound Med Biol 2015; 41: 960–966.

16.

Xiao

Zeng

Niu

et al.

Computer-aided diagnosis based on quantitative elastographic features with supersonic shear wave imaging. Ultrasound Med Biol 2014; 40: 275–286.

17.

Zhang

Xiao

Chen

et al.

Quantification of elastic heterogeneity using contourlet-based texture analysis in shear-wave elastography for breast tumor classification. Ultrasound Med Biol 2015; 41: 588–600.

18.

Dobruch-Sobczak

Nowicki

. Role of shear wave sonoelastography in differentiation between focal breast lesions. Ultrasound Med Biol 2015; 41: 366–374.

19.

Blank

Antaki

. Breast lesion elastography region of interest selection and quantitative heterogeneity: a systematic review and meta-analysis. Ultrasound Med Biol 2017; 43: 387–397.

20.

Obuchowski

. Nonparametric analysis of clustered ROC curve data. Biometrics 1997; 53: 567–578.

21.

Youk

Son

Gweon

et al.

Quantitative lesion-to-fat elasticity ratio measured by shear-wave elastography for breast mass: which area should be selected as the fat reference?

PLoS One 2015; 10: e0138074–e0138074.

22.

Cosgrove

Berg

Dore

et al.

Shear wave elastography for breast masses is highly reproducible. Eur Radiol 2012; 22: 1023–1032.