Background: Elastography (strain or shear-wave) is a method that estimates tissue stiffness.
Introduction: The aim of this study is to evaluate the quantitative and semi-quantitative ultrasound
elastography methods for the diagnosis of BI-RADS 4a and BI-RADS 3 lesions, which are borderline
for biopsy and follow-up.
Materials and Methods: 175 consecutive women with 193 ultrasound-visible breast lesions were
classified on Conventional B-mode Ultrasonography (CUS) according to the BI-RADS scoring system.
Quantitative and semiquantitative values from ultrasound elastography in the form of strain
Elastography Ratio (SER), shear Wave Elastography (SWE) and Shear Wave Elastography Ratio
(SWER) were obtained. The lesions categorized as BI-RADS 4a and BI-RADS 3 on ultrasound
were subsequently re-categorized according to the elastography values.
Results: Except for the 13 BI-RADS 2 lesions, the remaining 180 lesions were biopsied. Pathology
showed 83 lesions to be benign and 97 to be malignant. The sensitivity and specificity of the CUS
were 96.9% and 75.0%, respectively with an accuracy of 86.0%. Cut-off points calculated based on
ROC curves were 56.8 kPa for SWE, 3.53 for SWER and 3.81 for SER. When we downgraded BIRADS
4a lesions based on elastography results, the specificity (CUS+SER 96.9%, CUS+SWE
91.7%, and CUS+SWER 90.6%) and the accuracy (CUS+SER 95.3%, CUS+SWE 92.7%, and
CUS+SWER 92.2%) were shown to be better than CUS. When we upgraded BI-RADS 3 lesions
based on elastography results, the sensitivity of combined sets of SWE (99,0%) and SWER
(100,0%) was better than CUS.
Conclusion: The rate of false-negative biopsies can be decreased with the combined use of elastography