Highlights
- •Combined B-mode US and Emax had the highest improvement in specificity and accuracy compared with B-mode.
- •Emax (cutoff, 145.7kPa) appeared to be the most discriminatory parameter.
- •The sensitivity of SWE parameters in combination with B-mode US was significantly lower than B-mode US alone.
Abstract
Purpose
To investigate the most effective cutoff values for shear-wave elastography (SWE)
for differentiating benign and malignant breast lesions and to evaluate the diagnostic
performance of quantitative and qualitative SWE in combination with B-mode ultrasound
(US).
Methods
209 breast lesions from 200 patients were evaluated with B-mode US and SWE. Pathologic
results determined by US-guided core needle biopsy or surgical excisions were used
as a reference standard. Qualitative (four-color pattern) and quantitative analyses
(Emean, Emax, SD, and E ratio) were performed. The cut-off values were defined using
Youden's index. The diagnostic performance of B-mode US and combination of B-mode
US with four-color pattern or quantitative parameters were compared.
Results
Of the 209 breast lesions, 102 were benign and 107 were malignant. All qualitative
and quantitative SWE parameters had significantly higher specificity, positive predictive
value (PPV), and accuracy compared to B-mode US (p < 0.001). The optimal cutoff values
for the Emax, Emean, SD and E ratio were 145.7 kPa, 89.1 kPa, 11.9, and 3.84, respectively.
The optimal cutoff for color pattern was between 3 and 4. Combined B-mode US and Emax
had the highest improvement, from 17.65% to 98.04% for specificity and from 58.85%
to 82.78% for accuracy, with a decrease in sensitivity compared with B-mode.
Conclusion
Quantitative and qualitative SWE combined with B-mode US improved the accuracy to
differentiate benign from malignant lesions. Emax (cutoff, 145.7 kPa) appeared to
be the most discriminatory parameter.
Abbreviations:
SWE (shear-wave elastography), US (ultrasound), Emax (max elasticity), Emean (mean elasticity), Eratio (elasticity ratio), SD (standard deviation)Keywords
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Article info
Publication history
Published online: May 03, 2018
Accepted:
May 1,
2018
Received in revised form:
April 13,
2018
Received:
September 11,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
