Shear Wave Elastography of Breast Lesions: Quantitative Analysis of Elastic Heterogeneity Improves Diagnostic...

The aim of this study was to evaluate whether quantitative analysis of elastic heterogeneity (EH) could improve the diagnostic performance of shear wave elastography (SWE) in breast lesions. From August 2016 to August 2017, 280 patients were enrolled in this prospective study. All lesions were evaluated with the ultrasound Breast Imaging Reporting and Data System (BI-RADS) and SWE with Virtual Touch tissue imaging quantification. The shear wave velocity (SWV) of the three areas of highest stiffness and lowest stiffness within the lesions were measured to calculate the maximum SWV (SWV_max), mean SWV (SWV_mean) and EH. The EH was determined as the difference between the averaged highest SWV and lowest SWV. The diagnostic performance-including the area under the receiver operating characteristic curve (AUC) and the sensitivity and specificity of BI-RADS, EH, SWV_max and SWV_mean-were analyzed. The AUC of EH, SWV_max and SWV_mean were 0.963, 0.949 and 0.937, respectively. The sensitivity of EH was 93.75%, which was significantly higher than that of SWV_max (84.37%) and SWV_mean (84.37%) (p < 0.001); there was no significant difference in the specificity among EH, SWV_max and SWV_mean (p > 0.05). For category 4A lesions, EH predicted all the malignant lesions, while two cancers were misdiagnosed by SWV_max and SWV_mean, respectively. Quantitative analysis of EH can improve the sensitivity of SWE for the differential diagnosis of breast lesions without loss of specificity.