Wendie A. Berg MD, PhD, Presenter: Research grant, Naviscan, Inc Researcher, Naviscan, Inc Speaker, SuperSonic Imagine Researcher, SuperSonic Imagine Medical Advisory Board, Koninklijke Philips Electronics NV Author, Gamma Medica Ideas, License, Merge Healthcare

Ellen Bachman Mendelson MD, Abstract Co-Author: Scientific Advisory Board, Hologic, Inc Research support, Siemens AG Speakers Bureau, Siemens AG Medical Advisory Board, Quantason, LLC Consultant, Quantason, LLC Speakers Bureau, SuperSonic Imagine Research support, SuperSonic Imagine Medical Advisory Board, Toshiba Corporation

David Owen Cosgrove MBBCh, FRCR, Abstract Co-Author: Research Consultant, SuperSonic Imagine Research Consultant, Bracco Group Speakers Bureau, Toshiba Corporation

Caroline J. Doré BSC, Abstract Co-Author: Statistical Consultant SuperSonic Imagine

Joel Gay, Abstract Co-Author: Employee, SuperSonic Imagine

Jean-Pierre Henry, Abstract Co-Author: Employee, SuperSonic Imagine

Claude Cohen Bacrie MD, PhD, Abstract Co-Author: Executive Vice President, SuperSonic Imagine Officer, SuperSonic Imagine

To compare quantitative maximum breast mass stiffness on SWE with histopathologic outcome.

From 9/2008 to 9/2010, across 16 centers in Europe and USA, 1647 women with breast masses consented to repeat ultrasound and quantitative SWE imaging (SuperSonic Imagine, Aix, France). 1562 women/masses had acceptable reference standard. Quantitative maximum elasticity (Emax) across three acquisitions was recorded, with range set 0 (very soft) to 180 kPa (very stiff). Median Emax, and interquartile ranges were determined as a function of histopathology, and compared using Mann-Whitney tests.

Median patient age: 50 yrs (mean 51.8; SD 14.5; range 21 to 94); lesion diameter, 12 mm (mean 14; SD 7.9; range 1 to 53). Median Emax across 1562 masses (32.1% malignant) was 71 (mean 90; SD 65; IQR 31 to 170). Of 501 malignancies, 23 (4.6%) were DCIS with Emax 126 (IQR 71 to 180), less stiff than 467 invasive carcinomas [Emax 180 (IQR 138 to 180; p=.0017)]; 12 other malignancies had Emax 170 (IQR 54 to 180). Overall, benign lesions were much softer than malignancies (Emax 43, IQR 24 to 83; vs. 180, IQR 129 to 180; p<.0001). Eight lipomas (Emax 14, IQR 8 to 15), 154 cysts (Emax 29, IQR 9 to 58) and 7 IMLN (Emax 17, IQR 9 to 40) were softer than other benign lesions (p<.0001 for lipomas and cysts; p=.007 for IMLN). Aspirated cysts were stiffer than simple cysts: Emax 35 vs. 23 (p=.012). Common benign lesions were soft: 62 FCC (Emax 32, IQR 24 to 94); 51 stromal fibrosis (Emax 36, IQR 22 to 102); 299 fibroadenomata (Emax 45, IQR 30 to 79); 420 nonspecific benign/BI-RADS 2 no biopsy (Emax 45, IQR 25 to 85). High-risk lesions were slightly stiffer than common benign lesions (p=.002) but tended to be softer than DCIS (p=.14): 13 fibroepithelial lesions (Emax 68, IQR 29 to 170); 5 ADH/LCIS (Emax 82, IQR 42 to 132); 17 papillomata (Emax 100, IQR 41 to 176); 2 radial scars (Emax 104, IQR 29 to 180). 20 Fat necrosis (Emax 85; IQR 29 to 140) and 2 abscesses (Emax 133; IQR 87 to 180) were relatively stiff.

As groups, cysts, lipomas, and IMLN are softer than fibroadenomata, FCC, or fibrosis. High-risk lesions and DCIS are intermediate in stiffness. Invasive carcinomas are stiffer than any other class of breast masses.

Despite some overlap, maximum stiffness by SWE is highly effective at predicting the severity of histopathology of sonographically-depicted masses.

Berg, W, Mendelson, E, Cosgrove, D, Doré, C, Gay, J, Henry, J, Cohen Bacrie, C, Increasing Quantitative Maximum Stiffness by Shearwave Elastography (SWE) Predicts Increasingly Severe Histopathology of Breast Masses.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006989.html