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Objectives The purpose of this study is to evaluate the additive value of shear wave elastography (SWE) for differentiating benign and metastatic axillary lymph nodes (LNs) in breast cancer. Materials and methods The area under the receiver operating characteristic curve, sensitivity, and specificity of B-mode US, SWE, and combined modality were compared for 54 suspicious LNs. Results After combining information from SWE, sensitivity was significantly higher for combined modality than for B-mode US alone (94.12% vs. 82.35%, p = 0.046) without a decrease in specificity. Conclusion Combined B-mode US and SWE may improve detection of metastatic axillary LNs in patients with breast cancer.

Purpose To compare breast stiffness based on shear-wave elastography (SWE) quantitative parameters with histopathologic results diagnosed by ultrasound (US)-guided core needle biopsy (CNB) to determine their association with upgrade rates after surgical excision or follow-up US as well as clinico-radiologic differences between upgrade and non-upgrade groups. Materials and methods This retrospective study enrolled 225 breast lesions from 225 patients, including 159 benign lesions, 38 high risk lesions and 28 ductal carcinoma in situ (DCIS) diagnosed by US-guided CNB. Quantitative SWE parameters of breast lesions were measured before CNB and compared according to histopathologic results (benign, high risk and DCIS) and lesion size ( 20 mm). Clinico-radiologic and pathologic factors were compared between upgrade and non-upgrade groups after surgical excision or follow-up US. Results After surgical excision or follow-up US after more than one year, 29 lesions were upgraded for an overall upgrade rate of 12.9% (29/225). There were significant differences between upgrade and non-upgrade groups in age, mammographic category, US category, and sonographic features, including shape, margin, orientation, imaging-histologic correlation and E ratio. Patients with lesion upgrade were much older and had lesions characterized by significantly higher mammographic and US category (>4b), irregular shape, nonparallel orientation, microlobulated or angular margin, calcification in a mass, larger size on US (>20 mm) and greater imaging-histologic discordance. Multivariate analysis showed only mean and minimum elasticity values displayed a borderline association with histologic underestimation. Conclusion Upgrade of breast lesions diagnosed by US-guided CNB can be predicted using Emean and Emin among quantitative SWE parameters.

To investigate the most effective cutoff values for shear-wave elastography (SWE) for differentiating benign and malignant breast lesions and to evaluate the diagnostic performance of quantitative and qualitative SWE in combination with B-mode ultrasound (US).209 breast lesions from 200 patients were evaluated with B-mode US and SWE. Pathologic results determined by US-guided core needle biopsy or surgical excisions were used as a reference standard. Qualitative (four-color pattern) and quantitative analyses (Emean, Emax, SD, and E ratio) were performed. The cut-off values were defined using Youden's index. The diagnostic performance of B-mode US and combination of B-mode US with four-color pattern or quantitative parameters were compared.Of the 209 breast lesions, 102 were benign and 107 were malignant. All qualitative and quantitative SWE parameters had significantly higher specificity, positive predictive value (PPV), and accuracy compared to B-mode US (p 0.001). The optimal cutoff values for the Emax, Emean, SD and E ratio were 145.7 kPa, 89.1 kPa, 11.9, and 3.84, respectively. The optimal cutoff for color pattern was between 3 and 4. Combined B-mode US and Emax had the highest improvement, from 17.65% to 98.04% for specificity and from 58.85% to 82.78% for accuracy, with a decrease in sensitivity compared with B-mode.Quantitative and qualitative SWE combined with B-mode US improved the accuracy to differentiate benign from malignant lesions. Emax (cutoff, 145.7 kPa) appeared to be the most discriminatory parameter.

Purpose To investigate clinicopathologic and radiologic factors associated with false-negative results of magnetic resonance computer aided evaluation (MR-CAE) of breast MR imaging (MRI) in breast cancer patients. Materials and Methods A total of 135 breast cancer patients who underwent preoperative breast MR-CAE were included. False-negative and true-positive MR-CAE results were compared in terms of clinicopathologic and radiologic features. Univariate and multivariate analyses were used to evaluate independent factors associated with false-negative results. Result Six of 135 cancer patients (4.4%) were false negative on MRI. Conclusion Breast cancer with false-negative results on MR-CAE was classified as a lower BI-RADS category on breast ultrasound than true-positive results on MR-CAE.