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. 2022 Nov 24:12:1022917.
doi: 10.3389/fonc.2022.1022917. eCollection 2022.

Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world

Lei Tang  1   2 , Yuqun Wang  2 , Pingping Chen  2 , Man Chen  2 , Lixin Jiang  1
Affiliations

Clinical use and adjustment of ultrasound elastography for breast lesions followed WFUMB guidelines and recommendations in the real world

Lei Tang et al. Front Oncol. .

Abstract

Objective: This study aimed to explore the value of strain elastography (SE) and shear wave elastography (SWE) following the World Federation of Ultrasound in Medicine and Biology (WFUMB) guidelines and recommendations in the real world in distinguishing benign and malignant breast lesions and reducing biopsy of BI-RADS (Breast Imaging Reporting and Data System) 4a lesions.

Methods: This prospective study included 274 breast lesions. The elastography score (ES) by the Tsukuba score, the strain ratio (SR) for SE, and Emax for SWE of the lesion(A) and the regions(A') included the lesion and the margin (0.5-5 mm) surrounding the lesion were measured. The sensitivity, specificity, and AUC were calculated and compared by the cutoff values recommended by WFUMB guidelines.

Results: When scores of 1 to 3 were classified as probably benign by WFUMB recommendation, the ES was significantly higher in malignant lesions compared to benign lesions (p < 0.05) in all lesions. For the cohort by size >20 mm, the sensitivity was 100%, and the specificity was 45.5%. ES had the highest AUC: 0.79(95% CI 0.72-0.86) with a sensitivity of 96.2%, and a specificity of 61.8% for the cohort by size ≤20 mm. For the Emax-A'-S2.5mm, when the high stiffness would be considered with Emax above 80 kPa in SWE, the malignant lesions were diagnosed with a sensitivity of 95.8%, a specificity of 43.3% for all lesions, a sensitivity of 88.5% for lesions with size ≤20 mm, and sensitivity of 100.0% for lesions with size >20 mm. In 84 lesions of BI-RADS category 4a, if category 4a lesions with ES of 1-3 points or Emax-A'-S2.5 less than 80 kPa could be downgraded to category 3, 52 (61.9%) lesions could be no biopsy, including two malignancies. If category 4a lesions with ES of 1-3 points and Emax-A'-S2.5 less than 80kPa could be downgraded to category 3, 23 (27.4%) lesions could be no biopsy, with no malignancy.

Conclusions: The elastography score for SE and Emax-A' for SWE after our modification were beneficial in the diagnosis of breast cancer. The combination of SWE and SE could effectively reduce the biopsy rate of BI-RADS category 4a lesions.

Keywords: BI-RADS; biopsy; breast cancer; shear wave elastography; strain elastography.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer WZ declared a shared affiliation with the authors to the handling editor at the time of review.

Figures

Figure 1
Figure 1
The breast cancer was downgraded by the Emax-A’-S2.5 below 80kpa. A 65-year-old female patient had a lesion on her left breast. Pathologically confirmed intraductal solid papillary carcinoma. The size of the lesion was 6.6mm and ultrasound images of the breast lesion were evaluated as BI-RADS 4a (A), with an elasticity score of 5 (B), Emax-A of 63.8kpa and Emax-A’-S2.5 of 63.8kpa (C).
Figure 2
Figure 2
The breast cancer was downgraded by the ES of 1-3 points. A 47-year-old female patient had a lesion on her right breast. Pathologically confirmed middle-grade ductal carcinoma in situ. The size of the lesion was 9mm and ultrasound images of the breast lesion were evaluated as BI-RADS 4a (A), with an elasticity score of 3 (B), Emax-A of 82.9kpa and Emax-A’-S2.5 of 132.0kpa (C).
Figure 3
Figure 3
The fibroadenoma was downgraded by the ES of 1-3 points and the Emax-A’-S2.5 below 80kpa. A 67-year-old female patient had a lesion on her right breast. Pathologically confirmed fibroadenoma. The size of the lesion was 11.9mm and ultrasound images of the breast lesion were evaluated as BI-RADS 4a (A), with an elasticity score of 2 (B), Emax-A of 58.7kpa and Emax-A’-S2.5 of 59.71kpa (C).
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