Differentiation of benign from malignant solid breast masses: comparison of two-dimensional and three-dimensional shear-wave elastography

To prospectively compare the diagnostic performances of two-dimensional (2D) and three-dimensional (3D) shear-wave elastography (SWE) for differentiating benign from malignant breast masses. B-mode ultrasound and SWE were performed for 134 consecutive women with 144 breast masses before biopsy. Quantitative elasticity values (maximum and mean elasticity in the stiffest portion of mass, E-max and E-mean; lesion-to-fat elasticity ratio, E-rat) were measured with both 2D and 3D SWE. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity of B-mode, 2D, 3D SWE and combined data of B-mode and SWE were compared. Sixty-seven of the 144 breast masses (47 %) were malignant. Overall, higher elasticity values of 3D SWE than 2D SWE were noted for both benign and malignant masses. The AUC for 2D and 3D SWE were not significantly different: E-mean, 0.938 vs 0.928; E-max, 0.939 vs 0.930; E-rat, 0.907 vs 0.871. Either 2D or 3D SWE significantly improved the specificity of B-mode ultrasound from 29.9 % (23 of 77) up to 71.4 % (55 of 77) and 63.6 % (49 of 77) without a significant change in sensitivity. Two-dimensional and 3D SWE performed equally in distinguishing benign from malignant masses and both techniques improved the specificity of B-mode ultrasound. aEuro cent Shear-wave elastography (SWE) is increasingly used during ultrasound of the breast aEuro cent 2D and 3D SWE performed equally in distinguishing benign from malignant masses aEuro cent Either SWE method, combined with B-mode, outperformed B-mode ultrasound alone aEuro cent Quantitative elasticity was greater for 3D than 2D SWE for all masses.