[Can breast elastography change our strategies? Technology, impact and limitations]

Compression or static elastography is based on images deformation (induced by slight manual compression/decompression to the breast) and tissue movement is color-encoded in color map and classified into five scores of increasing malignancy (score of 1 to 3: benign and 4 to 5: malignant). The elasticity shear wave is measured from the propagation velocity of shear waves in the lesions and is expressed in kPa or m/s and in color map. Reproducibility is satisfactory for the two technologies even if the static elastography is only semi-quantitative. Elastography is helpful for lesions classified BI-RADS 3 and 4 and especially when the PPV of these lesions in B mode is low<10% (BI-RADS 3 and 4a). For these two technologies, cancer and biopsy rates are reduced by at least 30% (with threshold values for the shear wave technology of 30kPa and 3m/s depending on the manufacturer). False positives are found with the fibrotic lesions and false negatives by colloid tumors and DCIS. Correlation with prognostic factors is discussed.