Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases

Shear wave elastography (SWE) is an emerging technique which can obtain quantitative elasticity values in breast disease. We therefore evaluated the diagnostic performance of SWE for the differentiation of breast masses compared with conventional ultrasound (US). Conventional US and SWE were performed by three experienced radiologists for 158 consecutive women who had been scheduled for US-guided core biopsy or surgical excision in 182 breast masses (89 malignancies and 93 benign; mean size, 1.76 cm). For each lesion, quantitative elasticity was measured in terms of the Young's modulus (in kilopascals, kPa) with SWE, and BI-RADS final categories were assessed with conventional US. The mean elasticity values were significantly higher in malignant masses (153.3 kPa +/- A 58.1) than in benign masses (46.1 kPa +/- A 42.9), (P < 0.0001). The average mean elasticity values of invasive ductal (157.5 +/- A 57.07) or invasive lobular (169.5 +/- A 61.06) carcinomas were higher than those of ductal carcinoma in situ (117.8 kPa +/- A 54.72). The average mean value was 49.58 +/- A 43.51 for fibroadenoma, 35.3 +/- A 31.2 for fibrocystic changes, 69.5 +/- A 63.2 for intraductal papilloma, and 149.5 +/- A 132.4 for adenosis or stromal fibrosis. The optimal cut-off value, yielding the maximal sum of sensitivity and specificity, was 80.17 kPa, and the sensitivity and specificity of SWE were 88.8% (79 of 89) and 84.9% (79 of 93). The area under the ROC curve (Az value) was 0.898 for conventional US, 0.932 for SWE, and 0.982 for combined data. In conclusion, there were significant differences in the elasticity values of benign and malignant masses as well as invasive and intraductal cancers with SWE. Our results suggest that SWE has the potential to aid in the differentiation of benign and malignant breast lesions.