2D-SWE Ultrasound Elastography for Subpleural Consolidations: Validating a Novel Approach to Benign-Malignant Differentiation

Ultrasound elastography is a novel technology that assesses tissue elasticity. Elastography has been studied in subpleural consolidations, yet findings remain contradictory. This study aims to evaluate the utility of 2D-SWE for differentiating benign and malignant consolidations and to develop a simplified protocol accessible to inexperienced operators and applicable to all patients, regardless of clinical status. Prospective single-center study conducted in a tertiary care hospital. We enrolled 101 consecutive patients with consolidation identified on chest CT or X-ray. 2D-SWE was preferentially performed during forced inspiration; when unfeasible, measurements were acquired during end-expiration or spontaneous breathing. Quantitative measurements (shear wave speed, m/s; and elastic modulus, kPa), alongside qualitative elasticity scores, demonstrated statistically significant differences in distinguishing benign and malignant consolidations during multivariate analysis. ROC curve analysis identified optimal diagnostic cutoffs of 1.72 m/s and 9.1 kPa, both exhibiting 89% sensitivity and 80% specificity. The predominant measurement method was spontaneous breathing (90.1%). 2D-SWE effectively differentiates benign and malignant subpleural consolidations. Our simplified protocol, requiring only five valid measurements and adaptable to spontaneous breathing, if ratified in future studies, could replace complex techniques like prolonged apnea and serve as the standardized method in future clinical guidelines.