Investigations In Application Of Shear Wave Elastography In The Non-mass-like Breast Cancer Diagnosis

Breast cancer is the most common invasive cancer among females, and it is the biggest cause for cancer-related death.10%-15% breast cancer is non-mass-like (NML) in morphological classification which early accurate diagnosis is very difficult. Looking for accurate and reliable diagnostic method is urgently needed. This study explored the conventional ultrasound (US) and shear wave elasticity (SWE) imaging characteristics in NML, and analyzed the diagnostic performance in combined application of these above methods.Methods:1. Conventional US and SWE were performed and the imaging characteristics were analyzed for 208 patients (all patients are females) with 222 lesions. Finally,67 lesions from 63 patients were classified as NML breast lesions and were included in this current study. All NML breast lesions were scheduled for ultrasound (US)-guided core needle biopsy or vacuum-assisted biopsy or surgical excision to obtain the pathological results.2. The grey-scale ultrasonic characteristics and the Breast Imaging Reporting and Data System (BI-RADS) category in these lesions were analyzed.3. The pathological results indicated malignant in 33 lesions and benign in 34 lesions, and formed the malignant group and benign group respectively. The maximum elastic modulus (Emax), mean elastic modulus (Emean), minimum elastic modulus (Emin) and elastic modulus ratio between lesions and surrounding parenchyma (Eradio) in both groups were compared respectively. Analyze whether the stiff rim sign demonstrate in the peripheral region. Cut-off value and diagnostic sensitivity and specificity were obtained using Receiver Operating Characteristic Curves (ROC). Independent diagnostic performance in each SWE parameter was also compared with other ones.4. The diagnostic performance was evaluated for NML breast cancer by using the BI-RADS category combined with SWE parameters.Results:1. The max elastic modulus, mean elastic modulus, min elastic modulus, elastic modulus ratio and elasticity ratio between lesions and surrounding parenchyma in malignant group were all significantly higher than those of benign group{P< 0.05). The incidence of stiff rim sign in malignant lesions was significantly higher than that of benign lesions (P< 0.05).2. The Az value of max elastic modulus was higher than mean elastic modulus, min elastic modulus and elastic modulus ratio, but without statistical significance (P> 0.05).3. The specificity was significantly enhanced by using the combination of conventional US and max elastic modulus and the stiff rim sign compared with conventional US.4.23 lesions (67.6%) were prevented unnecessary negative biopsies in benign group by using the combinative application of conventional US and SWE.Conclusions:1. SWE could increase diagnostic specificity of NML breast lesions.2. The combination of conventional US and SWE could reduce unnecessary negative benign biopsies of NML lesions.