Myung Hwan Lee; Eun-Kyung Kim; Eun Ju Lee; Ha Yan Kim; Jung Hyun Yoon

doi:10.3348/jksr.2020.81.1.157

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Lee, Kim, Lee, Kim, and Yoon: Application of Point Shearwave Elastography to Breast Ultrasonography: Initial Experience Using “S-Shearwave” in Differential Diagnosis

Original Article

J Korean Soc Radiol 2020;81(1):157-165.

Published online: 7 January 2020

DOI: https://doi.org/10.3348/jksr.2020.81.1.157

Application of Point Shearwave Elastography to Breast Ultrasonography: Initial Experience Using “S-Shearwave” in Differential Diagnosis

Myung Hwan Lee¹

, Eun-Kyung Kim¹

, Eun Ju Lee²

, Ha Yan Kim²

, Jung Hyun Yoon^1,^∗

¹Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea

²Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea

^∗ Corresponding author Jung Hyun Yoon, MD Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel 82-2-2228-7400 Fax 82-2-393-3035 E-mail lvjenny@yuhs.ac

Received 2 May 201914 June 2019 Accepted 1 July 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the optimal measurement location, cut-off value, and diagnostic performance of S-Shearwave in differential diagnosis of breast masses seen on ultrasonography (US).

Materials and Methods

During the study period, 225 breast masses in 197 women were includ-ed. S-Shearwave measurements were made by applying a square region-of-interest automati-cally generated by the US machine. Shearwave elasticity was measured three times at four different locations of the mass, and the highest shearwave elasticity was used for calculating the optimal cut-off value. Diagnostic performance was evaluated by using the area under the receiv-ing operator characteristic curve (AUC).

Results

Of the 225 breast masses, 156 (69.3%) were benign and 69 (30.7%) were malignant. Mean S-Shearwave values were significantly higher for malignant masses (108.0 ± 70.0 kPa vs. 43.4 ± 38.3 kPa;p < 0.001). No significant differences were seen among AUC values at different measurement locations. With a cut-off value of 41.9 kPa, S-Shearwave showed 85.7% sensitivity, 63.9% specificity, 70.7% accuracy, and positive and negative predictive values of 51.7% and 90.8%, respectively. The AUCs for US and S-Shearwave did not show significant differences (p = 0.179).

Conclusion

S-Shearwave shows comparable diagnostic performance to that of grayscale US that can be applied for differential diagnosis of breast masses seen on US.

Index terms:

Index terms

Breast, Ultrasonography, Neoplasm, Elasticity Imaging Techniques

REFERENCES

1. American College of Radiology. Breast imaging reporting and data system. 5th ed. Reston, VA: American College of Radiology. 2013.

2. Hong AS, Rosen EL, Soo MS, Baker JA. BI-RADS for sonography: positive and negative predictive values of sonographic features. AJR Am J Roentgenol. 2005; 184:1260–1265.

3. Kim EK, Ko KH, Oh KK, Kwak JY, You JK, Kim MJ, et al. Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography. AJR Am J Roentgenol. 2008; 190:1209–1215.

4. Costantini M, Belli P, Lombardi R, Franceschini G, Mulè A, Bonomo L. Characterization of solid breast masses: use of the sonographic breast imaging reporting and data system lexicon. J Ultrasound Med. 2006; 25:649–659. quiz 661.

5. 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.

6. Lee EJ, Jung HK, Ko KH, Lee JT, Yoon JH. Diagnostic performances of shear wave elastography: which pa-rameter to use in differential diagnosis of solid breast masses? Eur Radiol. 2013; 23:1803–1811.

7. 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.

8. Berg WA, Cosgrove DO, Doré CJ, Schäfer FK, Svensson WE, Hooley RJ, et al. Shearwave elastography im-proves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 2012; 262:435–449.

9. Burnside ES, Hall TJ, Sommer AM, Hesley GK, Sisney GA, Svensson WE, et al. Differentiating benign from malignant solid breast masses with US strain imaging. Radiology. 2007; 245:401–410.

10. Cho N, Moon WK, Kim HY, Chang JM, Park SH, Lyou CY. Sonoelastographic strain index for differentiation of benign and malignant nonpalpable breast masses. J Ultrasound Med. 2010; 29:1–7.

11. 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.

12. Choi K, Kong D, Hah Z, Lee HK. A reliability index of shear wave speed measurement for shear wave elastography. Piscataway: IEEE;2015.

13. Deffieux T, Gennisson JL, Bercoff J, Tanter M. On the effects of reflected waves in transient shear wave elastography. IEEE Trans Ultrason Ferroelectr Freq Control. 2011; 58:2032–2035.

14. Tozaki M, Isobe S, Fukuma E. Preliminary study of ultrasonographic tissue quantification of the breast using the acoustic radiation force impulse (ARFI) technology. Eur J Radiol. 2011; 80:e182–187.

15. Wojcinski S, Brandhorst K, Sadigh G, Hillemanns P, Degenhardt F. Acoustic radiation force impulse imaging with Virtual Touch TM tissue quantification: mean shear wave velocity of malignant and benign breast masses. Int J Womens Health. 2013; 5:619–627.

16. Tozaki M, Isobe S, Sakamoto M. Combination of elastography and tissue quantification using the acoustic radiation force impulse (ARFI) technology for differential diagnosis of breast masses. Jpn J Radiol. 2012; 30:659–670.

17. Teke M, Göya C, Teke F, Uslukaya Ö, Hamidi C, Çetinçakmak MG, et al. Combination of virtual touch tissue imaging and virtual touch tissue quantification for differential diagnosis of breast lesions. J Ultrasound Med. 2015; 34:1201–1208.

18. Evans A, Whelehan P, Thomson K, McLean D, Brauer K, Purdie C, et al. Quantitative shear wave ultrasound elastography: initial experience in solid breast masses. Breast Cancer Res. 2010; 12:R104.

Fig. 1.

Example of application of S-Shearwave to breast ultrasonography examination. A. A square ROI is set at the center of the breast mass for shearwave elasticity measurement. B. An ROI is set at the normal breast parenchyma adjacent to the breast mass, with the ROI set at the same depth as that of the breast mass.

Fig. 2.

After generating the S-Shearwave, shearwave elasticity is measured three times at four different locations of the mass by applying square regions-of-interest – interior (mass center), superior border, right lateral border, and left lateral border of the mass.

Table 1.

Comparison of Mean S-Shearwave Values between Breast Masses

	Benign (n = 156)			Malignancy (n = 69)			p^†
	Mass	Parenchyma	p^∗	Mass	Parenchyma	p^∗	p^†
Mass center	29.0 ± 30.0	18.3 ± 15.3	< 0.001	72.0 ± 67.4	13.1 ± 9.2	< 0.001	< 0.001
Superior margin	33.9 ± 77.8	18.3 ± 15.3	< 0.001	77.6 ± 58.1	13.1 ± 9.2	< 0.001	< 0.001
Right lateral margin	26.8 ± 26.8	18.3 ± 15.3	< 0.001	52.0 ± 47.4	13.1 ± 9.2	< 0.001	< 0.001
Left lateral margin	27.2 ± 27.7	18.3 ± 15.3	< 0.001	53.4 ± 41.5	13.1 ± 9.2	< 0.001	< 0.001

Data are displayed as mean ± standard deviation (kPa).

^∗ Comparison of mean elasticity values between benign masses and surrounding parenchyma.

^† Comparison of mean elasticity values between benign and malignant masses in the four measurement locations.

Table 2.

Diagnostic Performance of S-Shearwave According to Measurement Location

	Mass Center	Superior Margin	Right Lateral Margin	Left Lateral Margin	Overall p
Cut-off level^∗ (kPa)	> 25.8	> 32.2	> 24.1	> 29.5	-
Sensitivity	80.0 (70.6–89.4)	82.9 (74.0–91.7)	68.6 (57.7–79.5)	70.0 (59.3–80.7)	0.024
Specificity	63.2 (55.6–70.8)	63.9 (56.3–71.4)	70.3 (63.1–77.5)	74.2 (67.3–81.1)	0.014
PPV	49.6 (40.3–58.8)	50.9 (41.7–60.1)	51.1 (41.0–61.2)	55.1 (44.7–65.4)	0.521
NPV	87.5 (81.4–93.6)	89.2 (83.4–95.0)	83.2 (76.8–89.6)	84.6 (78.5–90.6)	0.189
Accuracy	68.4 (62.4–74.5)	69.8 (68.8–75.8)	69.8 (63.8–75.8)	72.9 (67.1–78.7)	0.586
AUC	0.716 (0.656–0.777)	0.734 (0.675–0.792)	) 0.695 (0.629–0.760)	0.721 (0.657–0.785)	> 0.999

95% confidence intervals are in parentheses.

^∗ Cut-off level is calculated by Youden's index with the maximum S-Shearwave elasticity among the median values calculated from the three elasticity measurements obtained from each location.

AUC = area under the receiver operator characteristics curve, NPV = negative predictive value, PPV = positive predictive value

Table 3.

Diagnostic Performance of S-Shearwave and US for the 225 Breast Masses

	S-Shearwave^∗	US Alone	p
Sensitivity	85.7 (77.5–93.9)	98.6 (96,2–100.0)	0.002
Specificity	63.9 (56.3–71.4)	58.3 (51.0–66.5)	0.332
PPV	51.7 (42.6–60.8)	51.1 (43.8–60.7)	0.888
NPV	90.8 (85.4–96.2)	98.9 (96.2–100.0)	0.002
NPV Accuracy	90.8 (85.4–96.2)70.7 (64.7–76.6)	98.9 (96.2–100.0) 70.7 (65.7–77.5)	0.002 0.821
AUC	0.748 (0.692–0.804)	0.794 (0.755–0.832)	0.179

95% confidence intervals are in parentheses.

^∗ Cut-off level of S-Shearwave in general is used as 41.9 kPa.

AUC = area under the receiver operator characteristics curve, NPV = negative predictive value, PPV = positive predictive value, US = ultrasonograpy

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