Restricted accessResearch articleFirst published online 2018-6-28
Evaluation of shear wave elastography for differential diagnosis of breast lesions: A new qualitative analysis versus conventional quantitative analysis
To evaluate a special kind of ultrasound (US) shear wave elastography for differential diagnosis of breast lesions, using a new qualitative analysis (i.e. the elasticity score in the travel time map) compared with conventional quantitative analysis.
METHODS:
From June 2014 to July 2015, 266 pathologically proven breast lesions were enrolled in this study. The maximum, mean, median, minimum, and standard deviation of shear wave speed (SWS) values (m/s) were assessed. The elasticity score, a new qualitative feature, was evaluated in the travel time map. The area under the receiver operating characteristic (AUROC) curves were plotted to evaluate the diagnostic performance of both qualitative and quantitative analyses for differentiation of breast lesions.
RESULTS:
Among all quantitative parameters, SWS-max showed the highest AUROC (0.805; 95% CI: 0.752, 0.851) compared with SWS-mean (0.786; 95% CI:0.732, 0.834; P = 0.094), SWS-median (0.775; 95% CI:0.720, 0.824; P = 0.046), SWS-min (0.675; 95% CI:0.615, 0.731; P = 0.000), and SWS-SD (0.768; 95% CI:0.712, 0.817; P = 0.074). The AUROC of qualitative analysis in this study obtained the best diagnostic performance (0.871; 95% CI: 0.825, 0.909, compared with the best parameter of SWS-max in quantitative analysis, P = 0.011).
CONCLUSIONS:
The new qualitative analysis of shear wave travel time showed the superior diagnostic performance in the differentiation of breast lesions in comparison with conventional quantitative analysis.
TorreLA, BrayF, SiegelRL, FerlayJ, Lortet-TieulentJ, JemalA. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.
2.
ShenS, ZhouY, XuY, ZhangB, DuanX, HuangR, et al. A multi-centre randomised trial comparing ultrasound vs mammography for screening breast cancer in high-risk Chinese women. Br J Cancer. 2015;112(6):998–1004.
3.
AthanasiouA, TardivonA, TanterM, Sigal-ZafraniB, BercoffJ, DeffieuxT, et al. Breast lesions: Quantitative elastography with supersonic shear imaging–preliminary results. Radiology. 2010;256(1):297–303.
4.
BaiM, DuL, GuJ, LiF, JiaX. Virtual touch tissue quantification using acoustic radiation force impulse technology: Initial clinical experience with solid breast masses. J Ultrasound Med. 2012;31(2):289–94.
5.
BergWA, CosgroveDO, DoreCJ, SchaferFK, SvenssonWE, HooleyRJ, et al. Shear-wave elastography improves the specificity of breast US: The BE1 multinational study of 939 masses. Radiology. 2012;262(2):435–49.
6.
DestounisS, ArienoA, MorganR, MurphyP, SeifertP, SomervilleP, et al. Clinical experience with elasticity imaging in a community-based breast center. J Ultrasound Med. 2013;32(2):297–302.
7.
GarraBS. Imaging and estimation of tissue elasticity by ultrasound. Ultrasound Q. 2007;23(4):255–68.
8.
ItohA, UenoE, TohnoE, KammaH, TakahashiH, ShiinaT, et al. Breast disease: Clinical application of US elastography for diagnosis. Radiology. 2006;239(2):341–50.
9.
ZhouJ, ZhanW, ChangC, ZhangX, JiaY, DongY, et al. Breast lesions: Evaluation with shear wave elastography, with special emphasis on the “stiff rim” sign. Radiology. 2014;272(1):63–72.
10.
CosgroveDO, BergWA, DoreCJ, SkybaDM, HenryJP, GayJ, et al. Shear wave elastography for breast masses is highly reproducible. Eur Radiol. 2012;22(5):1023–32.
11.
EvansA, WhelehanP, ThomsonK, McLeanD, BrauerK, PurdieC, et al. Quantitative shear wave ultrasound elastography: Initial experience in solid breast masses. Breast Cancer Res. 2010;12(6):R104.
12.
BarrRG, ZhangZ. Shear-wave elastography of the breast: Value of a quality measure and comparison with strain elastography. Radiology. 2015;275(1):45–53.
13.
GolattaM, Schweitzer-MartinM, HarcosA, SchottS, GomezC, StieberA, et al. Evaluation of virtual touch tissue imaging quantification, a new shear wave velocity imaging method, for breast lesion assessment by ultrasound. Biomed Res Int. 2014;2014:960262.
14.
IanculescuV, CiolovanLM, DunantA, VielhP, MazouniC, DelalogeS, et al. Added value of Virtual Touch IQ shear wave elastography in the ultrasound assessment of breast lesions. Eur J Radiol. 2014;83(5):773–7.
15.
LiDD, XuHX, GuoLH, BoXW, LiXL, WuR, et al. Combination of two-dimensional shear wave elastography with ultrasound breast imaging reporting and data system in the diagnosis of breast lesions: A new method to increase the diagnostic performance. Eur Radiol. 2016;26(9):3290–300.
16.
LiXL, XuHX, BoXW, LiuBJ, HuangX, LiDD, et al. Value of Virtual Touch Tissue Imaging Quantification for evaluation of ultrasound Breast Imaging-Reporting and Data System Category 4 Lesions. Ultrasound Med Biol. 2016;42(9):2050–7.
17.
ParajulySS, LanPY, YunMB, GangYZ, HuaZ. Diagnostic potential of strain ratio measurement and a 5 point scoring method for detection of breast cancer: Chinese experience. Asian Pac J Cancer Prev. 2012;13(4):1447–52.
18.
ZhaoQL, RuanLT, ZhangH, YinYM, DuanSX. Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method. Eur J Radiol. 2012;81(11):3245–9.
19.
ChenYP, HanT, WuR, YaoMH, XuG, ZhaoLX, et al. Comparison of Virtual Touch Tissue Quantification and Virtual Touch Tissue Imaging Quantification for diagnosis of solid breast tumors of different sizes. Clin Hemorheol Microcirc. 2016;64(2):235–44.
20.
XiangLH, YaoMH, XuG, PuH, LiuH, FangY, et al. Diagnostic value of contrast-enhanced ultrasound and shear-wave elastography for breast lesions of sub-centimeter. Clin Hemorheol Microcirc. 2017;67(1):69–80.
21.
ZhangSP, ZengZ, LiuH, YaoMH, XuG, WuR. Combination of conventional ultrasonography and virtual touch tissue imaging quantification for differential diagnosis of breast lesions smaller than 10mm. Clin Hemorheol Microcirc. 2017;67(1):59–68.
22.
DeLongER, DeLongDM, Clarke-PearsonDL. Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach. Biometrics. 1988;44(3):837–45.
23.
MainieroMB, LourencoA, MahoneyMC, NewellMS, BaileyL, BarkeLD, et al. ACR Appropriateness Criteria Breast Cancer Screening. J Am Coll Radiol. 2016;13(11S):R45–R49.
24.
TangW, HuFX, ZhuH, WangQF, GuYJ, PengWJ. Digital breast tomosynthesis plus mammography, magnetic resonance imaging plus mammography and mammography alone: A comparison of diagnostic performance in symptomatic women. Clin Hemorheol Microcirc. 2017;66(2):105–16.
25.
CosgroveD, PiscagliaF, BamberJ, BojungaJ, CorreasJM, GiljaOH, et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med. 2013;34(3):238–53.
26.
BarrRG, NakashimaK, AmyD, CosgroveD, FarrokhA, SchaferF, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 2: Breast. Ultrasound Med Biol. 2015;41(5):1148–60.
27.
GolattaM, Schweitzer-MartinM, HarcosA, SchottS, JunkermannH, RauchG, et al. Normal breast tissue stiffness measured by a new ultrasound technique: Virtual touch tissue imaging quantification (VTIQ). Eur J Radiol. 2013;82(11):e676–9.
28.
GongX, WangY, XuP. Application of real-time ultrasound elastography for differential diagnosis of breast tumors. J Ultrasound Med. 2013;32(12):2171–6.
29.
TozakiM, SaitoM, BensonJ, FanL, IsobeS. Shear wave velocity measurements for differential diagnosis of solid breast masses: A comparison between virtual touch quantification and virtual touch IQ. Ultrasound Med Biol. 2013;39(12):2233–45.
30.
LiuB, ZhengY, ShanQ, LuY, LinM, TianW, et al. Elastography by acoustic radiation force impulse technology for differentiation of benign and malignant breast lesions: A meta-analysis. J Med Ultrason. 2016;43(1):47–55.
31.
LiuB, ZhengY, HuangG, LinM, ShanQ, LuY, et al. Breast Lesions: Quantitative diagnosis using ultrasound shear wave elastography-a systematic review and meta-analysis. Ultrasound Med Biol. 2016;42(4):835–47.
32.
YaoMH, WuR, XuG, ZhaoLX, LiuH, PuH, et al. A novel two-dimensional quantitative shear wave elastography to make differential diagnosis of breast lesions: Comprehensive evaluation and influencing factors. Clin Hemorheol Microcirc. 2016;64(2):223–33.
33.
LiuH, ZhaoLX, XuG, YaoMH, ZhangAH, XuHX, et al. Diagnostic value of virtual touch tissue imaging quantification for benign and malignant breast lesions with different sizes. Int J Clin Exp Med. 2015;8(8):13118–26.
34.
CongR, LiJ, GuoS. A new qualitative pattern classification of shear wave elastograghy for solid breast mass evaluation. Eur J Radiol. 2017;87, 111–19.
35.
YangYP, XuXH, GuoLH, HeYP, WangD, LiuBJ, et al. Qualitative and quantitative analysis with a novel shear wave speed imaging for differential diagnosis of breast lesions. Sci Re. 2017;7, 40964.
36.
BarrRG. Shear wave imaging of the breast: Still on the learning curve. J Ultrasound Med. 2012;31(3):347–50.
37.
EvansA, WhelehanP, ThomsonK, BrauerK, JordanL, PurdieC, 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(2):224–9.
