Value of Strain Elastography Ultrasound in Differentiation of Benign and Malignant Breast Masses with Histopathological Correlation

Introduction: Breast cancer is currently one of the leading causes of cancer deaths in women. Early detection and accurate classification of suspicious masses as benign or malignant is important for arriving at an appropriate treatment plan. Elastography has shown potential in differentiating benign from malignant breast tumors.

Objective: To evaluate the usefulness of Strain Elastography ultrasound in differentiation of benign and malignant breast masses taken histopathology as Gold Standard.

Methods: This cross-sectional study was carried out in the Department of Radiology and Imaging, BIRDEM, Dhaka, from July 2017 to June 2019. A total of 92 female patients with breast masses were enrolled in this study. Strain Elastography Ultrasound and histopathology were done in all these patients. Statistical analyses of the results were obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22).

Results: The validity test of B-mode ultrasonography for differentiation of benign and malignant breast mass has sensitivity 95.0%, specificity 71.2%, accuracy 81.5% and positive predictive value 71.7% and negative predictive value 94.9%. Strain Score has sensitivity 85.0%, specificity 92.3%, accuracy 89.1%, positive predictive value 89.5% and negative predictive value 88.9%. Strain ratio has sensitivity 87.5%, specificity 94.2%, accuracy 91.3%, positive predictive value 92.1% and negative predictive value 90.7%. The validity test of Combined (B-mode sonography and Elastography) has sensitivity 97.5%, specificity 96.2%, accuracy 96.7%, positive predictive value 95.1% and negative predictive value 98.0%. The areas under the curve (AUCs) from the receiver operating characteristic (ROC) curves were 0.948 for ACR-BIRADS classification, 0.986 for Strain Score, 0.956 for Strain Ratio and 0.990 for combination.

Conclusion: The combination of strain elastography with B-mode ultrasonography has the potential to improve the differentiation of benign and malignant breast masses.