Kyung Hee Ko, Presenter: Nothing to Disclose

Hae Kyoung Jung MD, Abstract Co-Author: Nothing to Disclose

Jung Hyun Yoon MD, Abstract Co-Author: Nothing to Disclose

Hye Rin Kim, Abstract Co-Author: Nothing to Disclose

To evaluate the usefulness of SWE for the differential Diagnosis of small (≤2cm) breast lesions

From June 2012 to December 2012, of 215 women who had been performed conventional US and SWE, 165 masses of 155 women (mean age: 44.97±9.54 years, range 22-87 years) who had 2cm and smaller lesions were included in this study. All patients underwent US guided core biopsy or surgical excision. US BI-RADS final assessment and quantitative SWE parameters were recorded. Final assessments of the 165 breast lesions were categorized as follows: category 3 in 23, category 4a in 119, category 4b in 11, category 4c in 8, and category 5 in 4. Histopathologic diagnosis was used as reference standard. Optimal cutoff value for each quantitative SWE parameter was calculated by ROC curve. Calculated cutoff value was used to upgrade BI-RADS 3 lesions to category 4a and downgrade BI-RADS 4a lesions to category 3.

Of the 165 small breast masses, 20 masses (12%) were malignant and 145 masses (88%) were benign. Mean Emax of malignant masses (141.97±98.03kPA) was significantly higher than that of benign (49.14±39.89kPa). Emax with a cutoff value of 87.5kPa had the highest Az value (0.796, sensitivity 75.0%, specificity 85.5%, PPV 41.7%, NPV 96.1%). However, for small masses equal or smaller than 1cm, Az values of all quantitative SWE parameters were lower than 0.6. After adding SWE to conventional US, there was no improvement of diagnostic performance (sensitivity 80%, specificity 95.2%, PPV 69.6%, NPV 97.2%). When applying Emax <87.5 to downgrade BI-RADS category 4a to BI-RADS category 3, we could reduce benign biopsy rate from 84 %(102/122) to 62 %(26/42).

Small malignant masses≤2cm were significantly stiffer than small benign lesions. However adding SWE parameters to conventional US showed no improvement of diagnostic performance. SWE could give US BI-RADS some help for reducing benign biopsy rate.

SWE could give conventioanl US BI-RADS some help on differential diagnosis of small breast masses 2cm or smaller with reducing benign biopsy rate.

Ko, K, Jung, H, Yoon, J, Kim, H, Clinical Application of Shear Wave Elastography (SWE) in the Differential Diagnosis of Small (≤2cm) Breast Lesions.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13028624.html