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Shear-wave Elastography Improves Second-Viewing of Breast US

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shearwaveOhio researches have discovered that by adding shear-wave elastography to a second-viewing breast ultrasound study conducted after dynamic contrast-enhanced MRI (DCE-MRI) can identify almost a third more cancers than B-mode ultrasound.

A study of 73 women showed, shear-wave elastography bumped up cancer identification on a second-viewing ultrasound by 31%.

Director of breast imaging at University Hospitals Case Medical Center in Cleveland, Dr. Donna Plecha noted shear-wave elastography has a high negative predictive value, increasing the prospects that findings will have a correlation with pathology; and its ability to detect subtle cancers during second-look ultrasound after DCE-MRI.

Following DCE-MRI, second-look ultrasound offers visualization of lacerations and gives-way to instant ultrasound-directed biopsy. Shear-wave elastography assesses rigidity by determining proliferation shear waves within tissue.

Therefore 73 women (ages 21-84 with average age of 52) received shear-wave elastography during their second-look ultrasound after one or more abrasions were found on DCE-MRI.

MRI studies were carried-out on either a Magnetom Avanto or Magnetom Espree 1.5-tesla scanner using a specialized breast coil. Lacerations that were BI-RADS category 4 and 5 after DCE-MRI were assessed using second-look ultrasound, with both B-mode ultrasound and shear-wave elastography completed using an Aixplorer ultrasound system with a 12-5 MHz linear-array transducer.

Patients were originally scanned with B-mode ultrasound and if a correlation existed with the MRI-detected lesion, then shear-wave elastography was deployed to charter tissue rigidity.

Qualitative color shear-wave elastographic rigidity was used for all lacerations using a five-point color-scheme of highest elasticity in the accumulation and surrounding parenchyma.

All 96 lacerations were given ultrasound-guided or MRI-guided core biopsy and researchers documented pathology outcomes for all lacerations. Of the 96 lacerations, 28 (29%) were malignancies, 14 (14%) were high-risk lesions, and 55 (57%) were benign.

Assembling elastography findings into weaker abrasions (elastography color scale of 1 or 2) and stronger abrasions (elastography color scale of 3, 4, and 5), shear-wave elastography had sensitivity of 95.2%, specificity of 70%, positive predictive value of 71.4%, and negative predictive value of 91%.

Abrasions seen on second-look ultrasound were more likely to be of a cancerous origin than those seen only on MRI  (p = 0.006). Shear-wave elastography detected five of the 50 abrasions seen on second-look ultrasound, all of which were invasive cancer. Four were invasive ductal carcinoma and one was an invasive lobular carcinoma.

Of the abrasions detected with DCE-MRI, 84 (87%) were masses; 48 (57%) were also found on second-look ultrasound, thus eliminating the need for an MRI biopsy. The remaining 12 (13%) were nonmass developments, with two (17%) detected on ultrasound. Ultrasound was significantly more likely to find mass enhancement (p = 0.012).

"Ultrasound-guided biopsy of DCE-MRI BI-RADS category 4 or 5 lesions remains preferable to MRI biopsy because of its relative ease, lower cost, and improved patient comfort. The high negative predictive value of the five-point color score of maximum elasticity may help with the confidence level of the radiologist when correlating a benign biopsy result with the B-mode ultrasound image,” said Plecha.

For now the next stage of research for Plecha and her team is to involve more patients in an attempt to raise statistical significance.

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