Role of US elastography in the diagnosis of breast cancer

Abstract Introduction Elastography is a clinical imaging technique that assesses tissue stiffness by comparing the elasticity of a target region with that of surrounding tissue. In breast imaging, it is employed to evaluate the stiffness of breast lesions, aiding in their characterization. When integrated with B-mode ultrasound (US), elastography enhances the ability to distinguish between benign, malignant, and suspicious lesions. The aim of this study was to compare the histological findings of the breast tissue with their elastographic values and determine whether the latter, being a non-invasive technique, can help to avoid unnecessary biopsies. Furthermore, we aim to identify cutoff values that may indicate malignancy of the lesion. Materials and methods A retrospective study was conducted involving 40 women who underwent both shear wave elastography (SWE) and breast tissue biopsy. During the conventional B-mode ultrasound examination, SWE was also performed to obtain quantitative elasticity measurements. The SWE parameters included the maximum stiffness value within the lesion ( E ), the stiffness of the perilesional adipose tissue, and the corresponding elasticity ratio ( E -ratio). Histopathological analysis of biopsy samples was used to confirm the nature of the lesions and to serve as the reference standard for diagnostic accuracy. In addition, B-mode ultrasound findings were compared with those obtained from SWE to assess their diagnostic performance. Results 40 breast lesions were analyzed. E-ratio values tended to be lower in B2 lesions, consistent with benign pathology, and higher in B4–B5 lesions, suggesting malignancy. Malignant lesions also demonstrated greater heterogeneity and significantly higher stiffness values compared to benign lesions. Conclusions Qualitative assessment of lesion elasticity and perilesional tissue stiffness demonstrated good discriminatory performance in differentiating breast lesions identified on ultrasound. These findings support the use of shear wave elastography as a complementary tool to conventional B-mode ultrasound in the diagnostic evaluation of breast masses.