Integrating morphology, vascularity, and elasticity: diagnostic role of multiparametric quantitative ultrasound in breast lesions

To determine the incremental diagnostic value of multiparametric quantitative ultrasound-integrating B-mode, Color Doppler, Strain, and Shear Wave Elastography (SWE)-in differentiating benign and malignant breast lesions, using histopathology/FNAC as the gold standard.

Seventy patients with 87 breast lesions underwent comprehensive ultrasound by a resident and a consultant radiologist (> 20 years' experience) with consensus reporting. Each lesion was evaluated using B-mode (BI-RADS), Color Doppler (vascularity, resistive and pulsatility indices), Strain elastography (strain ratio), and SWE (stiffness in kPa). Pathological correlation was available for all lesions. Diagnostic performance of individual and combined parameters was assessed using sensitivity, specificity, PPV, NPV, accuracy, and ROC analysis. Multivariate logistic regression evaluated incremental value of multiparametric combinations.

B-mode had the highest sensitivity (88.37%) and accuracy (82.76%), Color Doppler the highest specificity (95.45%) but low sensitivity (55.81%), while Strain and SWE showed balanced performance, with SWE achieving the highest accuracy (85.06%) and AUC (0.85). Adding Color Doppler or Strain to B-mode provided no additional benefit. Incorporating SWE improved specificity (88.64%) and accuracy (85.06%). B-mode + Strain + Color Doppler achieved 83.91% accuracy, whereas B-mode + SWE + Color Doppler provided the highest overall performance (sensitivity 86.05%, specificity 86.36%, accuracy 86.21%, AUC 0.86). The four-parameter model (B-mode + Color Doppler + Strain + SWE) showed 83.72% sensitivity, 86.36% specificity, AUC 0.85, and 85.06% accuracy, performing comparably but marginally inferior to the best triple combination (B-mode + Color Doppler + SWE), likely due to redundancy and threshold effects, indicating that adding Strain did not improve performance.

Multiparametric ultrasound enhances lesion differentiation. B-mode ensures sensitivity, Color Doppler confirms benign vascular patterns, and SWE provides quantitative stiffness assessment. Combining morphology, vascularity, and stiffness-particularly B-mode + SWE + Color Doppler-yields the highest diagnostic accuracy.