Korean J Radiol.  2020 Feb;21(2):172-180. 10.3348/kjr.2019.0453.

Shear-Wave Elastography of the Breast: Added Value of a Quality Map in Diagnosis and Prediction of the Biological Characteristics of Breast Cancer

• Zheng X
• Huang Y
• Liu Y
• Wang Y
• Mao R
• Li F
• Cao L
• Zhou J

• KMID: 2471634
• DOI: http://doi.org/10.3348/kjr.2019.0453

Abstract

OBJECTIVE
To determine the added value of a shear-wave elastography (SWE) quality map (QM) in the diagnosis of breast lesions and in predicting the biological characteristics of invasive breast cancer.
MATERIALS AND METHODS
Between January 2016 and February 2019, this study included 368 women with 368 pathologically proven breast lesions, which appeared as poor-quality regions in the QM of SWE. To measure shear-wave velocity (SWV), seven regions of interest were placed in each lesion with and without QM guidance. Under QM guidance, poor-quality areas were avoided. Diagnostic performance was calculated for mean SWV (SWV(mean)), max SWV (SWV(max)), and standard deviation (SD) with QM guidance (SWV(mean) + QM, SWV(max) + QM, and SD + QM, respectively) and without QM guidance (SWV(mean) − QM, SWV(max) − QM, and SD − QM, respectively). For invasive cancers, the relationship between SWV findings and biological characteristics was investigated with and without QM guidance.
RESULTS
Of the 368 women (mean age, 47 years; SD, 10.8 years) enrolled, 159 had benign breast lesions and 209 had malignant breast lesions. SWV(mean) + QM (3.6 ± 1.39 m/s) and SD + QM (1.02 ± 0.84) were significantly different from SWV(mean) − QM (3.29 ± 1.22 m/s) and SD − QM (1.46 ± 1.06), respectively (all p < 0.001). For differential diagnosis of breast lesions, the sensitivity and areas under the receiver operating characteristic curve (AUC) of SWV(mean) + QM (sensitivity: 89%; AUC: 0.932) were better than those of SWV(mean) − QM (sensitivity, 84.2%; AUC, 0.912) (all p < 0.05). There was no significant difference in sensitivity and specificity between SD + QM and SD − QM (all p = 1.000). Among the biological characteristics of invasive cancers, lymphovascular involvement, axillary lymph node metastasis, negative estrogen receptor status, negative progesterone receptor status, positive human epidermal growth factor receptor status, and aggressive molecular subtypes showed higher SWV(mean) + QM (all p < 0.05), while only lymphovascular involvement showed higher SWV(mean) − QM (p = 0.036).
CONCLUSION
The use of QM in SWE might improve the diagnostic performance for breast lesions and facilitate prediction of the biological characteristics of invasive breast cancers.

Keyword

Breast; Shear-wave elastography; Ultrasound; Quality map; Diagnostic performances; Biological characteristics

MeSH Terms

Area Under Curve
Breast Neoplasms*
Breast*
Diagnosis*
Diagnosis, Differential
Elasticity Imaging Techniques*
Estrogens
Female
Humans
Lymph Nodes
Neoplasm Metastasis
Population Characteristics*
Receptor, Epidermal Growth Factor
Receptors, Progesterone
ROC Curve
Sensitivity and Specificity
Ultrasonography
Estrogens
Receptor, Epidermal Growth Factor
Receptors, Progesterone

Figure

• 

  Fig. 1 Study flow diagram. QM = quality map, SWE = shear-wave elastography, US = ultrasound

• 

  Fig. 2 Quality evaluation standard of QM. A. Breast lesion (arrows) is displayed as evenly green in QM, which indicates good quality. B. Quality of this breast lesion (arrows) is considered as poor, and yellow components in QM should be avoided while measuring SWV. C. Quality of this breast lesion (arrows) is considered to be poor, and red and yellow components in QM should be avoided while measuring SWV. SWV = shear-wave velocity

• 

  Fig. 3 Invasive ductal carcinoma in 53-year-old woman. A. Lesion (arrows) is classified as Breast Imaging Reporting and Data System 4C on B-mode US. B. Lesion (arrows) shows poor quality in QM of SWE. C. Mean SWV without QM guidance (SWVmean − QM) of breast lesion (arrows) is 2.97 m/s, misdiagnosing this lesion as benign. D. Mean SWV with QM guidance (SWVmean + QM) of breast lesion (arrows) is 3.17 m/s, assessing this lesion as malignant.

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