Intra- and Interobserver Reproducibility of Shear Wave Elastography for Evaluation of the Breast Lesions

Min Ji Hong; Hak Hee Kim

doi:10.3348/jksr.2017.76.3.198

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Hong and Kim: Intra- and Interobserver Reproducibility of Shear Wave Elastography for Evaluation of the Breast Lesions

Original Article

J Korean Soc Radiol 2017;76(3):198-205.

Published online: 7 January 2017

DOI: https://doi.org/10.3348/jksr.2017.76.3.198

Intra- and Interobserver Reproducibility of Shear Wave Elastography for Evaluation of the Breast Lesions

Min Ji Hong¹, Hak Hee Kim^∗,²

¹Department of Radiology, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea

²Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea

^∗ Corresponding author: Hak Hee Kim, MD Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel. 82-2-3010-4390 Fax. 82-2-476-0090 E-mail: hhkim@amc.seoul.kr

Received 13 July 20164 October 2016 Accepted 24 November 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate reproducibility of shear wave elastography (SWE) for breast lesions within and between observers and compare the reproducibility of SWE features.

Materials and Methods

For intraobserver reproducibility, 225 masses with 208 patients were included; and two consecutive SWE images were acquired by each observer. For interobserver reproducibility, SWE images of the same mass were ob-tained by another observer before surgery in 40 patients. Intraclass correlation coefficients (ICC) were used to determine intra- and interobserver reproducibility.

Results

Intraobserver reliability for mean elasticity (Emean) and maximum elasticity (Emax) were excellent (ICC = 0.803, 0.799). ICC for SWE ratio and minimum elasticity (Emin) were fair to good (ICC = 0.703, 0.539). Emean showed excellent ICC regardless of histopathologic type and tumor size. Emax, SWE ratio and Emin represented excellent or fair to good reproducibility based on histopathologic type and tumor size. In interobserver study, ICC for Emean, Emax and SWE ratio were excellent. Emean, Emax and SWE ratio represented excellent ICC irrespective of histopathologic type. ICC for Emean was excellent regardless of tumor size. SWE ratio and Emax showed fair to good interobserver reproducibility based on tumor size. Emin represented poor interobserver reliability.

Conclusion

Emean in SWE was highly reproducible within and between observers.

Index terms:

Index terms

Breast, Ultrasonography, Elasticity Imaging Techniques, Breast Neoplasm

REFERENCES

1. Tanter M, Bercoff J, Athanasiou A, Deffieux T, Gennisson JL, Montaldo G, et al. Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging. Ultrasound Med Biol. 2008; 34:1373–1386.

2. Athanasiou A, Tardivon A, Tanter M, Sigal-Zafrani B, Bercoff J, Deffieux T, et al. Breast lesions: quantitative elastography with supersonic shear imaging–preliminary results. Radiology. 2010; 256:297–303.

3. Sewell CW. Pathology of benign and malignant breast dis-orders. Radiol Clin North Am. 1995; 33:1067–1080.

4. Hall TJ, Zhu Y, Spalding CS. In vivo real-time freehand pal-pation imaging. Ultrasound Med Biol. 2003; 29:427–435.

5. Konofagou EE, D'hooge J, Ophir J. Myocardial elastogra-phy–a feasibility study in vivo. Ultrasound Med Biol. 2002; 28:475–482.

6. Ophir J, Garra B, Kallel F, Konofagou E, Krouskop T, Righet-ti R, et al. Elastographic imaging. Ultrasound Med Biol. 2000; 26(Suppl 1):S23–S29.

7. Park CS, Kim SH, Jung NY, Choi JJ, Kang BJ, Jung HS. Interobserver variability of ultrasound elastography and the ultrasound BI-RADS lexicon of breast lesions. Breast Cancer. 2015; 22:153–160.

8. Chang JM, Moon WK, Cho N, Yi A, Koo HR, Han W, et al. Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat. 2011; 129:89–97.

9. Cosgrove DO, Berg WA, Doré CJ, Skyba DM, Henry JP, Gay J, et al. Shear wave elastography for breast masses is highly reproducible. Eur Radiol. 2012; 22:1023–1032.

10. Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004; 51:396–409.

11. Bercoff J, Tanter M, Muller M, Fink M. The role of viscosity in the impulse diffraction field of elastic waves induced by the acoustic radiation force. IEEE Trans Ultrason Ferroelectr Freq Control. 2004; 51:1523–1536.

12. Bercoff J, Chaffai S, Tanter M, Sandrin L, Catheline S, Fink M, et al. In vivo breast tumor detection using transient elastography. Ultrasound Med Biol. 2003; 29:1387–1396.

13. Tozaki M, Fukuma E. Pattern classification of ShearWave™ Elastography images for differential diagnosis between benign and malignant solid breast masses. Acta Radiol. 2011; 52:1069–1075.

14. Yoon JH, Jung HK, Lee JT, Ko KH. Shearwave elastography in the diagnosis of solid breast masses: what leads to false-negative or false-positive results? Eur Radiol. 2013; 23:2432–2440.

15. Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006; 239:341–350.

16. Zhu QL, Jiang YX, Liu JB, Liu H, Sun Q, Dai Q, et al. Real-time ultrasound elastography: its potential role in assessment of breast lesions. Ultrasound Med Biol. 2008; 34:1232–1238.

17. Raza S, Odulate A, Ong EM, Chikarmane S, Harston CW. Us-ing real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med. 2010; 29:551–563.

18. Hudson JM, Milot L, Parry C, Williams R, Burns PN. Inter- and intra-operator reliability and repeatability of shear wave elastography in the liver: a study in healthy volunteers. Ultrasound Med Biol. 2013; 39:950–955.

19. Ferraioli G, Tinelli C, Zicchetti M, Above E, Poma G, Di Gre-gorio M, et al. Reproducibility of real-time shear wave elastography in the evaluation of liver elasticity. Eur J Radiol. 2012; 81:3102–3106.

20. Hiltawsky KM, Krüger M, Starke C, Heuser L, Ermert H, Jen-sen A. Freehand ultrasound elastography of breast lesions: clinical results. Ultrasound Med Biol. 2001; 27:1461–1469.

21. Yoon JH, Kim MH, Kim EK, Moon HJ, Kwak JY, Kim MJ. Interobserver variability of ultrasound elastography: how it affects the diagnosis of breast lesions. AJR Am J Roentgenol. 2011; 196:730–736.

22. Mun HS, Choi SH, Kook SH, Choi Y, Jeong WK, Kim Y. Vali-dation of intra- and interobserver reproducibility of shear-wave elastography: phantom study. Ultrasonics. 2013; 53:1039–1043.

23. Ng WL, Rahmat K, Fadzli F, Rozalli FI, Mohd-Shah MN, Chandran PA, et al. Shearwave elastography increases diagnostic accuracy in characterization of breast lesions. Medicine (Baltimore). 2016; 95:e3146.

24. Kim SJ, Ko KH, Jung HK, Kim H. Shear wave elastography: is it a valuable additive method to conventional ultrasound for the diagnosis of small (≤2 cm) breast cancer? Medicine (Baltimore). 2015; 94:e1540.

25. Lee SH, Cho N, Chang JM, Koo HR, Kim JY, Kim WH, et al. Two-view versus single-view shear-wave elastography: comparison of observer performance in differentiating benign from malignant breast masses. Radiology. 2014; 270:344–353.

Fig. 1.

Conventional US and elastographic images of invasive ductal carcinoma in a 49-year-old woman. A. Conventional US image shows an irregular hypoechoic lesion without circumscribed margin. B. Shear wave elastography images of quantification box (Q-Box^TM) applies on the stiffest part of mass. An additional Q-Box^TM is placed in the ad-jacent surrounding tissue. US = ultrasonography

Table 1.

Pathologic Diagnosis of 228 Breast Lesions in 208 Patients

Pathologic Diagnosis	No. of Lesions
Malignant lesions (n = 174)
Invasive ductal carcinoma	133
Ductal carcinoma in situ	22
Mucinous carcinoma	6
Tubular carcinoma	5
Invasive lobular carcinoma	3
Microinvasive ductal carcinoma	2
Invasive mammary carcinoma	2
Secretory carcinoma	1
Benign lesions (n = 51)
Fibroadenoma	29
Intraductal papilloma	5
Adenosis	4
Other proliferative breast lesion without atypia	5
Nonproliferative breast change	5
Columnar cell change	1
Fibroadenomatoid change	1
Pseudoangiomatous stromal hyperplasia	1

Table 2.

Intraobserver Reproducibility of Quantitative SWE Measurements

	Overall		Benign		Malignancy
	ICC	95% CI	ICC	95% CI	ICC	95% CI
SWE ratio^∗	0.703	0.606 to 0.801	0.636	0.452 to 0.821	0.668	0.555 to 0.780
Emean^†	0.803	0.760 to 0.845	0.754	0.571 to 0.876	0.762	0.692 to 0.833
Emax^‡	0.799	0.744 to 0.855	0.744	0.648 to 0.889	0.769	0.667 to 0.822
Emin^§	0.539	0.419 to 0.660	0.491	0.115 to 0.868	0.498	0.360 to 0.637

^∗ SWE ratio was the ratio between the mean elasticity value in the mass divided by the mean elasticity value in the fat.

^† E mean was the mean value in the Q-Box ^TM of the mass as calculated by the system.

^‡ E maximum mass was the maximum value in the Q-Box ^TM of the mass as calculated by the system.

^§ E minimum mass was the minimum value in the Q-Box ^TM of the mass as calculated by the system.

CI = confidence interval, ICC = intraclass correlation coefficients, SWE = shear wave elastography

Table 3.

Intraobserver Reproducibility of Quantitative Shear Wave Elastography Measurements in Patients with Invasive Cancer Versus with Ductal Carcinoma in situ

	Ductal Carcinoma in situ		Invasive Cancer
	ICC	95% CI	ICC	95% CI
SWE ratio^∗	0.832	0.688 to 0.976	0.650	0.531 to 0.770
Emean^†	0.879	0.788 to 0.970	0.744	0.681 to 0.806
Emax^‡	0.897	0.821 to 0.973	0.718	0.637 to 0.799
Emin^§	0.677	0.394 to 0.959	0.475	0.319 to 0.631

^∗ SWE ratio was the ratio between the mean elasticity value in the mass divided by the mean elasticity value in the fat.

^† E mean was the mean value in the Q-Box ^TM of the mass as calculated by the system.

^‡ E maximum mass was the maximum value in the Q-Box ^TM of the mass as calculated by the system.

^§ E minimum mass was the minimum value in the Q-Box ^TM of the mass as calculated by the system.

CI = confidence interval, ICC = intraclass correlation coefficients, SWE = shear wave elastography

Table 4.

Intraobserver Reproducibility of Quantitative SWE Measurements according to the Mass Diameter

	Diameter ≤ 10 mm		10 mm < Diameter ≤ 15 mm		15 mm < Diameter ≤ 22 mm		Diameter > 22 mm
	ICC	95% CI	ICC	95% CI	ICC	95% CI	ICC	95% CI
SWE ratio^∗	0.718	0.585 to 0.852	0.634	0.412 to 0.856	0.746	0.622 to 0.870	0.644	0.446 to 0.842
Emean^†	0.869	0.811 to 0.927	0.758	0.626 to 0.831	0.760	0.680 to 0.839	0.804	0.732 to 0.875
Emax^‡	0.891	0.848 to 0.934	0.752	0.665 to 0.839	0.740	0.656 to 0.825	0.770	0.646 to 0.893
Emin^§	0.592	0.412 to 0.772	0.603	0.443 to 0.762	0.504	0.301 to 0.707	0.435	0.157 to 0.712

Diameter was the largest measurement of the mass.

^∗ SWE ratio was the ratio between the mean elasticity values in the mass divided by the mean elasticity value in the fat.

^† E mean was the mean value in the Q-Box ^TM of the mass as calculated by the system.

^‡ E maximum mass was the maximum value in the Q-Box ^TM of the mass as calculated by the system.

^§ E minimum mass was the minimum value in the Q-Box ^TM of the mass as calculated by the system.

CI = confidence interval, ICC = intraclass correlation coefficients, SWE = shear wave elastography

Table 5.

Interobserver Reproducibility of Quantitative SWE Measurements

	Overall		Benign		Malignancy
	ICC	95% CI	ICC	95% CI	ICC	95% CI
SWE ratio^∗	0.787	0.714 to 1.000	0.902	0.535 to 1.000	0.752	0.687 to 1.000
Emean^†	0.909	0.558 to 1.000	0.879	0.486 to 1.000	0.906	0.481 to 1.000
Emax^‡	0.868	0.661 to 1.000	0.951	0.596 to 1.000	0.831	0.588 to 1.000
Emin^§	0.394	0.000 to 0.828	0.745	0.183 to 1.000	0.341	0.000 to 0.797

^∗ SWE ratio was the ratio between the mean elasticity values in the mass divided by the mean elasticity value in the fat.

^† E mean was the mean value in the Q-Box ^TM of the mass as calculated by the system.

^‡ E maximum mass was the maximum value in the Q-Box ^TM of the mass as calculated by the system.

^§ E minimum mass was the minimum value in the Q-Box ^TM of the mass as calculated by the system.

CI = confidence interval, ICC = intraclass correlation coefficients, SWE = shear wave elastography

Table 6.

Interobserver Reproducibility of Quantitative SWE Measurements according to the Mass Diameter

	Diameter ≤ 15 mm		Diameter > 15 mm
	ICC	95% CI	ICC	95% CI
SWE ratio^∗	0.423	0.565 to 1.000	0.760	0.587 to 1.000
Emean^†	0.878	0.000 to 0.856	0.903	0.343 to 1.000
Emax^‡	0.653	0.169 to 1.000	0.888	0.560 to 1.000
Emin^§	0.217	0.000 to 0.743	0.278	0.000 to 0.766

Diameter was the largest measurement of the mass.

^∗ SWE ratio was the ratio between the mean elasticity values in the mass divided by the mean elasticity value in the fat.

^† E mean was the mean value in the Q-Box ^TM of the mass as calculated by the system.

^‡ E maximum mass was the maximum value in the Q-Box ^TM of the mass as calculated by the system.

^§ E minimum mass was the minimum value in the Q-Box ^TM of the mass as calculated by the system.

CI = confidence interval, ICC = intraclass correlation coefficients, SWE = shear wave elastography

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