Shear-wave elastography improves the specificity of breast US: The BE1 multinational study of 939 masses

Wendie A. Berg, David O. Cosgrove, Caroline J. Doré, Fritz K.W. Schäfer, William E. Svensson, Regina J. Hooley, Ralf Ohlinger, Ellen B. Mendelson, Catherine Balu-Maestro, Martina Locatelli, Christophe Tourasse, Barbara C. Cavanaugh, Valérie Juhan, A. Thomas Stavros, Anne Tardivon, Joel Gay, Jean Pierre Henry, Claude Cohen-Bacrie

Research output: Contribution to journalArticle

523 Scopus citations

Abstract

Purpose: To determine whether adding shear-wave (SW) elastographic features could improve accuracy of ultrasonographic (US) assessment of breast masses. Materials and Methods: From September 2008 to September 2010, 958 women consented to repeat standard breast US supplemented by quantitative SW elastographic examination in this prospective multicenter institutional review board-approved, HIPAA-compliant protocol. B-mode Breast Imaging Reporting and Data System (BI-RADS) features and assessments were recorded. SW elastographic evaluation (mean, maximum, and minimum elasticity of stiffest portion of mass and surrounding tissue; lesion-tofat elasticity ratio; ratio of SW elastographic-to-B-mode lesion diameter or area; SW elastographic lesion shape and homogeneity) was performed. Qualitative color SW elastographic stiffness was assessed independently. Nine hundred thirty-nine masses were analyzable; 102 BI-RADS category 2 masses were assumed to be benign; reference standard was available for 837 category 3 or higher lesions. Considering BI-RADS category 4a or higher as test positive for malignancy, effect of SW elastographic features on area under the receiver operating characteristic curve (AUC), sensitivity, and specificity after reclassifying category 3 and 4a masses was determined. Results: Median participant age was 50 years; 289 of 939(30.8%) masses were malignant (median mass size, 12 mm). B-mode BI-RADS AUC was 0.950; eight of 303(2.6%) BI-RADS category 3 masses, 18 of 193(9.3%) category 4a lesions, 41 of 97 (42%) category 4b lesions, 42 of 57(74%) category 4c lesions, and 180 of 187(96.3%) category 5 lesions were malignant. By using visual color stiffness to selectively upgrade category 3 and lack of stiffness to downgrade category 4a masses, specifi city improved from 61.1% (397 of 650) to 78.5% (510 of 650) (P<.001); AUC increased to 0.962(P =.005). Oval shape on SW elastographic images and quantitative maximum elasticity of 80 kPa (5.2 m/sec) or less improved specificity (69.4% [451 of 650] and 77.4% [503 of 650], P<.001 for both), without significant improvement in sensitivity or AUC. Conclusion: Adding SW elastographic features to BI-RADS feature analysis improved specificity of breast US mass assessment without loss of sensitivity.

Original languageEnglish (US)
Pages (from-to)435-449
Number of pages15
JournalRadiology
Volume262
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Berg, W. A., Cosgrove, D. O., Doré, C. J., Schäfer, F. K. W., Svensson, W. E., Hooley, R. J., Ohlinger, R., Mendelson, E. B., Balu-Maestro, C., Locatelli, M., Tourasse, C., Cavanaugh, B. C., Juhan, V., Stavros, A. T., Tardivon, A., Gay, J., Henry, J. P., & Cohen-Bacrie, C. (2012). Shear-wave elastography improves the specificity of breast US: The BE1 multinational study of 939 masses. Radiology, 262(2), 435-449. https://doi.org/10.1148/radiol.11110640