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Eur Radiol. 2013 Oct;23(10):2695-704. doi: 10.1007/s00330-013-2873-3. Epub 2013 May 8.

Diagnostic value of commercially available shear-wave elastography for breast cancers: integration into BI-RADS classification with subcategories of category 4.

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Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-Gu, Seoul, 135-720, South Korea,



To evaluate the diagnostic performance of shear-wave elastography (SWE) for breast cancer and to determine whether the integration of SWE into BI-RADS with subcategories of category 4 improves the diagnostic performance.


A total of 389 breast masses (malignant 120, benign 269) in 324 women who underwent SWE before ultrasound-guided core biopsy or surgery were included. The qualitative SWE feature was assessed using a four-colour overlay pattern. Quantitative elasticity values including the lesion-to-fat elasticity ratio (Eratio) were measured. Diagnostic performance of B-mode ultrasound, SWE, or their combined studies was compared using the area under the ROC curve (AUC).


AUC of Eratio (0.952) was the highest among elasticity values (mean, maximum, and minimum elasticity, 0.949, 0.939, and 0.928; P = 0.04) and AUC of colour pattern was 0.947. AUC of combined studies was significantly higher than for a single study (P < 0.0001). When adding SWE to category 4 lesions, lesions were dichotomised according to % of malignancy: 2.1 % vs. 43.2 % (category 4a) and 0 % vs. 100 % (category 4b) for Eratio and 2.4 % vs. 25.8 % (category 4a) for colour pattern (P < 0.05).


Shear-wave elastography showed a good diagnostic performance. Adding SWE features to BI-RADS improved the diagnostic performance and may be helpful to stratify category 4 lesions.


• Quantitative and qualitative shear-wave elastography provides further diagnostic information during breast ultrasound. • The elasticity ratio (E ratio ) showed the best diagnostic performance in SWE. • E ratio and four-colour overlay pattern significantly differed between benign and malignant lesions. • SWE features allowed further stratification of BI-RADS category 4 lesions.

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