Diagnostic accuracy of contrast-enhanced ultrasound synchronized with shear wave elastography in the differential diagnosis of benign and malignant breast lesions: a diagnostic test

Huiling He; Xiaojin Wu; Meijuan Jiang; Zhikang Xu; Xuanxuan Zhang; Jianlian Pan; Xinyu Fu; Yunkai Luo; Jian Chen

doi:10.21037/gs-22-684

Diagnostic accuracy of contrast-enhanced ultrasound synchronized with shear wave elastography in the differential diagnosis of benign and malignant breast lesions: a diagnostic test

Gland Surg. 2023 Jan 1;12(1):54-66. doi: 10.21037/gs-22-684. Epub 2023 Jan 13.

Authors

Huiling He^#¹, Xiaojin Wu^#², Meijuan Jiang², Zhikang Xu², Xuanxuan Zhang¹, Jianlian Pan³, Xinyu Fu¹, Yunkai Luo¹, Jian Chen¹

Affiliations

¹ Department of Ultrasound Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China.
² Zhejiang University School of Medicine, Hangzhou, China.
³ Department of Clinical and Research, Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China.

^# Contributed equally.

Abstract

Background: Breast cancer (BC) is one of the most common malignancies affecting women. Timely and accurate diagnosis is crucial for treatment and prognosis. Some studies have found that elastography combined with microperfusion characteristics, which are mostly described by contrast-enhanced ultrasound (CEUS), could help in the diagnosis of breast lesions. This study aimed to assess the diagnostic performance of CEUS synchronized with shear wave elastography (SWE) in discriminating between benign and malignant breast lesions by using real-time contrast elastography images to analyze shell elasticity and contrast intensity.

Methods: A total of 26 pathologically confirmed breast lesions in 26 patients were retrospectively reviewed. Each patient underwent conventional B-mode ultrasound, CEUS, and then SWE data was obtained from a frame of image that was almost identical to the B-mode and CEUS images when acquiring time to peak (TTP). Breast lesions were evaluated based on the Breast Imaging Reporting and Data System (BI-RADS) and quantitative characteristics that describe the stiffness and intensity of contrast of the 1.0-3.0 mm shell region. Quantitative aspects of the inner lesions and shell on the elastogram included the maximum (Emax), mean (Emean), and minimum (Emin) Young's moduli. Quantitative enhanced features included maximum (Imax) and mean (Imean) intensity. We took postoperative pathological results as the gold standard. Receiver operating characteristic (ROC) curves were used to compare the diagnostic efficacy of the 2 examination modalities, either alone or in combination.

Results: The age of the patients ranged from 23 to 76 years, with a 42.5-year average age. In all breast lesions, 19 were benign and 7 were malignant. SWE synchronized with CEUS can effectively improve the diagnostic performance of breast lesions, and Emean + Imean and Emax + Emean + Imean of shell at 1.0 mm both had the highest area under the curve (AUC) of 0.86 [95% confidence interval (CI): 0.67, 0.96], with the sensitivity and specificity of 71.43% and 89.47%, respectively.

Conclusions: The combination of CEUS and SWE has a better diagnostic value in differentiating benign and malignant breast lesions compared to separate techniques.

Keywords: Breast; contrast-enhanced ultrasound (CEUS); shear wave elastography (SWE); ultrasonography (US).