Diagnostic role of shear wave elastography for differentiating benign and malignant breast masses

Diagnostic value of mammography combined with ultrasound shear wave elastography and magnetic resonance imaging in breast cancer

Breast cancer is one of the most common malignancies affecting women worldwide, and an early diagnosis is critical for improving prognosis. The present study aimed to investigate the diagnostic value of mammography (MG) combined with ultrasound shear wave elastography (SWE) and magnetic resonance imaging (MRI) for the early screening of breast cancer. Patients with breast tumors who underwent lumpectomy at a single hospital between December 2021 and January 2023 were selected and categorized into a benign or malignant group based on pathological findings. All patients had undergone examinations with MG, SWE and MRI. Imaging parameters were subsequently compared between the two groups. A total of 93 patients with breast tumors were included in the study, comprising 37 individuals in the benign group and 56 in the malignant group. MG findings revealed that patients in the malignant group exhibited significantly higher incidences of high breast glandular density, irregular mass margins, unclear mass borders and axillary lymph node involvement compared with those in the benign group. SWE results indicated that the elasticity ratio of the lesion to fat, and the mean and maximum values of the elastic modulus were significantly lower in the benign group than in the malignant group. Additionally, MRI findings demonstrated that the MRI-measured maximum diameter was larger, and the prevalence of irregular lesion morphology, irregular mass margins, signal enhancement and type III time-signal intensity curves was greater in the malignant group compared with the benign group. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of MG + SWE + MRI were 94.6, 86.5, 91.4 and 91.4%, respectively. Furthermore, the diagnostic efficacy of this combination surpassed that of MG + SWE, MG + MRI and SWE + MRI (area under the curve, 0.906 vs. 0.767, 0.758 and 0.763, respectively). In conclusion, the combination of MG with SWE and MRI exhibits a superior performance in the early diagnosis of breast cancer, exhibiting higher diagnostic accuracy and reliability compared with pairwise combinations.

Usefulness of Combined Advanced Dynamic Contrast-Enhanced and Diffusion-Weighted MRI Over Ultrasonography in Differentiating Cancer From Benign Lesions in Dense Breasts

Aim To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in characterizing suspicious lesions in dense breasts compared to ultrasonography (USG). Materials and methods Eighty-two consecutive female patients with suspicious lesions in dense breast parenchyma showing the American College of Radiology Breast Imaging Reporting And Data System (ACR BI-RADS) c/d composition on mammography underwent USG, where 63 lesions of 63 patients were suspicious. They underwent multiparametric MRI, followed by histopathological evaluation (HPE) of the lesions. Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of USG and MRI in lesion characterization and the combined accuracy of DCE-MRI with DWI. The receiver operating characteristic (ROC) curve analysis provided the cut-off for the apparent diffusion coefficient (ADC) value. Results The sensitivity, specificity, and accuracy of USG were 91.7%, 63%, and 79.4%, respectively. Kinetic curve analysis on DCE-MRI showed a type I curve only in benign lesions. Malignant lesions predominantly showed a type III curve. The sensitivity, specificity, and accuracy of DCE-MRI were 95.8%, 78.5%, and 85.7%, respectively. The optimum cut-off ADC value was 1.05x10-3 mm2/s with sensitivity, specificity, and accuracy of 83.3 % each. The specificity and accuracy of combined DCE-MRI with DWI were 94.4% and 88.1%, respectively. Conclusion Advanced MRI, including a combination of DCE-MRI kinetics and DWI, would be more effective and accurate for lesion characterization in dense breasts and act as a superior problem-solving tool compared to USG in differentiating carcinoma from benign lesions.