Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2510-2519
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2510
Evaluation of internal and shell stiffness in the differential diagnosis of breast non-mass lesions by shear wave elastography
Ping Xu, Mei Wu, Min Yang, Juan Xiao, Zheng-Min Ruan, Lan-Ying Wu
Ping Xu, Min Yang, Lan-Ying Wu, Department of Ultrasound, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
Mei Wu, Zheng-Min Ruan, Department of Ultrasound, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
Juan Xiao, Evidence-based Medicine Center, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
Author contributions: Xu P, Wu M and Yang M wrote the manuscript; Wu M and Yang M designed the research; Xu P, Ruan ZM and Wu LY performed ultrasound examinations; Xu P and Xiao J analyzed the data. All authors participated in performing the research.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Second Hospital of Shandong University.
Informed consent statement: All patients were informed of the purpose and risk of the examination and signed an informed consent prior to ultrasonic guidance breast biopsy.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mei Wu, MD, Chief Doctor, Department of Ultrasound, The Second Hospital of Shandong University, No.247 Beiyuan Ave, Jinan 250033, Shandong Province, China. a_may0212@163.com
Received: February 24, 2020
Peer-review started: February 24, 2020
First decision: March 24, 2020
Revised: April 9, 2020
Accepted: April 24, 2020
Article in press: April 24, 2020
Published online: June 26, 2020
Processing time: 121 Days and 2.4 Hours
Abstract
BACKGROUND

The diagnostic specificity of conventional ultrasound for breast non-mass lesions (NMLs) is low at approximately 21%-43%. Shear wave elastography (SWE) can distinguish benign from malignant lesions by evaluating the internal and peripheral stiffness. SWE has good reproducibility and high diagnostic efficacy. However, there are very few independent studies on the diagnostic value of SWE in breast NMLs.

AIM

To determine the value of SWE in the differential diagnosis of breast NMLs.

METHODS

This study enrolled a total of 118 patients with breast NMLs who underwent SWE examinations in the Beijing Shijitan Hospital Affiliated to Capital Medical University and The Second Hospital of Shandong University from January 2019 to January 2020. The internal elastic parameters of the lesions were recorded, including maximum (Emax), mean (Emean) and minimum elastic values and the standard deviation. The following peripheral parameters were noted: Presence of a “stiff rim” sign; Emax, and Emean elasticity values within 1 mm, 1.5 mm, 2 mm, 2.5 mm and 3 mm from the edge of NMLs. The receiver operating characteristic curve of each parameter was drawn, and the areas under the curve were calculated.

RESULTS

Emax, Emean and elastic values, and the standard deviation of the internal elastic values in malignant NMLs were significantly higher than those in benign NMLs (P < 0.05). The percentage with the “stiff rim” sign in malignant NMLs was significantly higher than that in the benign group (P < 0.05), and Emax and Emean at the shell of 1 mm, 1.5 mm, 2 mm, 2.5 mm and 3 mm in the malignant group were all higher than those in the benign group (P < 0.05). Of the surrounding elasticity values, Emax of the shell at 2.5 mm in malignant NMLs had maximum areas under the curve of 0.900, and the corresponding sensitivity and specificity were 94.57% and 85.86%, respectively.

CONCLUSION

The “stiff rim” sign and multiple quantitative elastic values within and around the lesion had good diagnostic performance in the differential diagnosis of breast NMLs. Emax in peripheral tissue had better diagnostic efficiency than other parameters.

Keywords: Breast tumor, Shear wave elastography, Non-mass lesions, Stiff rim sign, Ultrasound, Diagnosis

Core tip: This study is the first to qualitatively and quantitatively analyze the stiffness in and around breast non-mass lesions. We found that the evaluation of stiffness around the breast non-mass lesions had a better differential diagnostic reference value.