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Xi Lin,1 Cai Chang,2,3 Changjun Wu,4 Qin Chen,5 Yulan Peng,6 Baoming Luo,7 Lina Tang,8 Jing Li,9 Jihui Zheng,10 Ruhai Zhou,11 Guanghe Cui,12 Ao Li,13 Xuemei Wang,14 Linxue Qian,15 Jianxing Zhang,16 Chaoyang Wen,17 Joel Gay,18 Huili Zhang,18 Anhua Li,1 Yaling Chen2,3 1State Key Laboratory of Oncology in Southern China, Department of Ultrasound, Sun Yat-Sen University Cancer Center, Guangzhou 510060, P. R. China; 2Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, P. R. China; 3Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, P. R. China; 4Department of Ultrasound, First Affiliated Hospital of Harbin Medical University, Harbin 150001, P. R. China; 5Department of Ultrasound, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China; 6Department of Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, P. R. China; 7Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510235, P. R. China; 8Department of Ultrasound, Fujian Provincial Cancer Hospital, Fuzhou 350014, P. R. China; 9Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, P. R. China; 10Department of Ultrasound, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, P. R. China; 11Department of Ultrasound, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo 315040, P. R. China; 12Department of Ultrasound, Binzhou Medical University Hospital, Binzhou 256603, P. R. China; 13Department of Ultrasound, Jiangsu Province Hospital, Nanjing 210029, P. R. China; 14Department of Ultrasound, The First Hospital of China Medical University, Shenyang 110001, P. R. China; 15Department of Ultrasound, Beijing Friendship Hospital of Capital Medical University, Beijing 100050, P. R. China; 16Department of Ultrasound, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, P. R. China; 17Department of Ultrasound, First Affiliated Hospital of PLA General Hospital, Beijing 100037, P. R. China; 18Supersonic Imagine, Aix-en-Provence, France Purpose: This study aimed to investigate the value of shear wave elastography (SWE) for characterization of breast masses in a Chinese population. Patients and methods: Two thousand two hundred seventy-three women consented to be prospectively enrolled for the characterization of breast masses with ultrasound and SWE. Breast masses were known from symptoms, palpability, and/or previous imaging screening with mammography and/or ultrasound. Correlation of SWE qualitative and quantitative features with malignancy risk and impact on diagnostic performance of combining SWE features were assessed, and the Breast Imaging Reporting and Data System (BI-RADS) scoring was calculated using histopathology as reference. Results: Data of 2,262 masses (median size: 13 mm; range: 1.3–50) from 2,262 patients (median age: 43 years; range: 18–91) were investigated, of which 752 (33.3%) were malignant. Sensitivity and specificity of BI-RADS diagnosis were 97.5% (733/752) and 54.8% (827/1,510), respectively. By logistic regression, the combination of maximum elasticity (Emax) measurements with BI-RADS assessments increased the area under the receiver operating characteristic curve from 0.908 (95% CI: 0.896–0.920) to 0.954 (95% CI: 0.944–0.962). Using Emax of 30 kPa or lower to selectively downgrade BI-RADS 4a masses to follow-up, and Emax of 160 kPa or higher to selectively upgrade BI-RADS 3 lesions to biopsy, specificity significantly increased from 54.8% (827/1,510) to 66.1% (998/1,510) (P

Objectives: To evaluate the additive value of ultrasound strain elastography (USE) to BI-RADS for the differentiation of benign and malignant breast small lesions. Methods: Breast masses (≤2 cm) with histological diagnosis examined by ultrasonography and USE in our department from April 2004 to December 2009 were reviewed. Conventional B-mode ultrasound findings were classified according to the BI-RADS classification. USE findings were classified according to the 5-point scale. Histological diagnosis was used as the reference standard. Results: 401 (246 benign (61.3%), 155 malignant (38.7%)) from 370 consecutive patients were included in the study. Sensitivity and specificity were 90.3%, 68.3% for BI-RADS; 72.3%, 91.9% for USE. The sensitivity of BI-RADS was better than that of USE (P<0.05), while the specificity of USE was better than that of BI-RADS (P<0.05). A revised BI-RADS combined with USE results was proposed in this study. Sensitivity and specificity were 83.9% and 87.8% for revised BI-RADS. The diagnostic performance of revised BI-RADS was better than BI-RADS (P<0.05). Conclusions: USE could give BI-RADS some help in the differentiation of benign and malignant breast small lesions. The addition of elastography to BI-RADS could improve the diagnostic performance in <2 cm lesions. [ABSTRACT FROM AUTHOR]