Incremental Value of Shear Wave Elastography and Contrast-Enhanced Ultrasound in the Differential Diagnosis of Breast Non-Mass-Like Lesions

Objective: To analyse the parameters of shear wave elastography (SWE) and contrast-enhanced ultrasound (CEUS) in breast non- mass-like lesions (NMLs) and to evaluate the added diagnostic value of SWE and CEUS when combined with B-mode ultrasound (US) for differentiating NMLs. Methods: A total of 118 NMLs from 115 patients underwent US, SWE, and CEUS examinations. The SWE parameter with the highest areas under the receiver operating characteristic (ROC) curves (Az) and independent variables of CEUS obtained by logistic regression were used to adjust the BI-RADS-US (Breast Imaging Reporting and Data System for Ultrasound) classification. The adjusted BI-RADS risk stratification was then compared with the original classification. Additionally, the diagnostic effectiveness of US+SWE, US+CEUS, and US+SWE+CEUS combinations was calculated and compared. Results: The "stiff rim sign" was used as the optimal SWE indicator for BI-RADS adjustment. CEUS diagnostic criteria for adjustment included enhancement intensity, enhancement size, and the presence of radial or penetrating vessels. The Az values of US+SWE+CEUS and US+CEUS combinations were significantly higher than that of US alone (P<0.05). However, there was no significant difference in the Az value of US+SWE and US (P = 0.072). US+SWE+CEUS combination showed significantly higher Az values compared to other combinations (P<0.05), and achieved the highest sensitivity and specificity. Conclusion: Adding SWE and CEUS to conventional US enhances diagnostic accuracy for NMLs, offering a meaningful incremental value for BI-RADS classification in the assessment of NMLs.