Diagnostic efficiency of compression elastography and shear wave elastography in the differential diagnosis of breast lumps

Introduction. To date, breast cancer is the most common malignant tumor and the main cause of cancer mortality among the female population. Traditional ultrasound diagnostics in B-mode and elastography in combination with mammography are widely used at the stages of clinical screening of breast cancer, and they also are the methods of differential diagnostic assessment of benign and malignant mammary tumors. Aim. To determine the efficiency of an integrated approach to the differential diagnosis of breast lumps using compression elastography and shear wave elastography in a comparative aspect. Materials and Methods. A prospective comprehensive ultrasound examination of breast was performed on 134 women aged 26 to 72 years (the average age was 49±6.3) having complains of pain feelings, feeling of fullness, and the presence of palpable masses in the breast. The examinations were performed using the expert-class ultrasound scanner Logiq S8 HD Clear (GE Healthcare, Milwaukee, WI, USA) with linear sensor 9L-D, frequency range being 8-10 MHz. All tumors were examined using standard ultrasound diagnostics in B-mode and elastography; they were also logged using the Breast Imaging Reporting & Data System (BIRADS). Results and Discussion. In 134 patients, 219 focal breast masses of various morphological genesis were detected echographically. All focal masses identified based on the findings of morphological studies were divided into two groups: The first group consisted of 154 (70.3%) formations corresponding to malignant genesis; the second group consisted of 65 (29.7%) formations in which the tumor growth was benign. In the first group, 16 (10.4%) formations had a type 2 elastogram, 27 (17.5%) formations – type 3, 36 (23.4%) – type 4, and 75 (48.7%) – type 5 in compression elastography. With compression elastography, the average stiffness index was 5.31±0.4 [3.6-16.2] for malignant tumors, while it was 1.76±0.14 [0.8-2.1; p<0.001] for benign tumors. During shear wave elastography in malignant tumors, the average stiffness value was 98.4±12.3 kPa, while it was 18.2±4.3 kPa (p<0.001) in benign tumors. Analyzing the findings of this study, the complex application of elastography in integration with the B-mode to the diagnosis of focal breast masses was accurate in 98.6% of cases. The sensitivity and specificity indices were 97.9% and 96.2%, respectively. Conclusions. An integrated approach to the application of these methods of echography with a B-mode has shown significantly high efficiency of ultrasound diagnostics.

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