Elastography in the diagnosis of breast lesions: comparison of different elastographic features

Background Breast elastography is a non-invasive and widely accessible method used in the differential diagnostic procedure in addition to B-mode imaging. Purpose To assess the role of elastographic features in the differentiation of breast lesions and to evaluate the importance of depth in the choice of reference fat tissue for the calculation of strain ratio. Material and Methods From January to August 2015, 242 breast lesions were evaluated using elastographic assessment based on qualitative and semi-quantitative parameters (color map, strain ratio, length ratio) as well as elastographic analysis. Histological findings were considered as gold-standard. Results Sensitivity and specificity of B-mode ultrasound imaging were 90% and 60%, respectively. Color map sensitivity was 98% and specificity 46%; strain ratio sensitivity 81% and specificity 70%; length ratio sensitivity 64% and specificity 76%. Combined analysis of these three elastographic features improved the overall diagnostic performance of any of the three parameters alone, yielded sensitivity similar to that of color map (95%) and specificity comparable to strain ratio and length ratio (70%). There was no significant difference in strain ratio obtained from the reference fat tissue at the same depth as the lesion and at a different depth (sensitivity 77% versus 84%; specificity 70% versus 68%; P < 0.001). Conclusion In our experience, elastography can improve ultrasound characterization of the lesion, particularly if elastographic analysis is performed.