Diagnostic utility of strain and shear wave ultrasound elastography in differentiation of benign and malignant solid breast lesions

Background The purpose of our study was to assess diagnostic performance and comparison of strain and shear wave ultrasound elastography for differentiation of benign and malignant breast lesions compared to histopathological diagnosis as a reference standard. Our single center study involved 100 female patients with 132 solid breast masses. All patients underwent supervision of medical history, clinical examination, conventional B-mode ultrasound which was evaluated according to the BIRADS (Breast Imaging Reporting and Data System), and strain and shear wave ultrasound elastography. Strain ratio for strain elastography, mean elasticity value, and stiff ratio for shear wave elastography were calculated. All breast lesions were biopsied. Comparison of the elastography results with the histopathological diagnoses was done. Results There was no statistically significant difference as regard the AUCs for calculated values of strain and shear wave ultrasound elastography (strain ratio, 0.916; mean elasticity, 0.884; and stiff ratio, 0.872; P > 0.05). The AUCs for the combined use of B-mode US and elastography techniques were improved as the following: B-mode + strain, 0.920; B-mode + shear wave 0.952 with a significant P value < 0.001. Higher diagnostic accuracy was noted with the combination of strain and shear wave elastography than each single elastographic modality (P = 0.02). Conclusions Ultrasound elastography of breast masses is a non-invasive procedure with high sensitivity. Strain and shear wave elastography had almost similar diagnostic performance and displayed higher diagnostic performance if combined with B-mode ultrasound which helps in decreasing the number of unneeded breast biopsies.