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Xu J, Zhang L, Wen W, He Y, Wei T, Zheng Y, Pan X, Li Y, Wu Y, Dong F, Zhang H, Cheng W, Xu H, Zhang Y, Bao L, Zhang X, Tang S, Liao J, Luo H, Zhao H, Tian J, Peng Y. Evaluation of standard breast ultrasonography by adding two-dimensional and three-dimensional shear wave elastography: a prospective, multicenter trial. Eur Radiol 2024; 34:945-956. [PMID: 37644151 DOI: 10.1007/s00330-023-10057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/17/2023] [Accepted: 06/30/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE To reduce the number of biopsies performed on benign breast lesions categorized as BI-RADS 4-5, we investigated the diagnostic performance of combined two-dimensional and three-dimensional shear wave elastography (2D + 3D SWE) with standard breast ultrasonography (US) for the BI-RADS assessment of breast lesions. METHODS A total of 897 breast lesions, categorized as BI-RADS 3-5, were subjected to standard breast US and supplemented by 2D SWE only and 2D + 3D SWE analysis. Based on the malignancy rate of less than 2% for BI-RADS 3, lesions assessed by standard breast US were reclassified with SWE assessment. RESULTS After standard breast US evaluation, 268 (46.1%) participants underwent benign biopsies in BI-RADS 4-5 lesions. By using separated cutoffs for upstaging BI-RADS 3 at 120 kPa and downstaging BI-RADS 4a at 90 kPa in 2D + 3D SWE reclassification, 123 (21.2%) participants underwent benign biopsy, resulting in a 54.1% reduction (123 versus 268). CONCLUSION Combining 2D + 3D SWE with standard breast US for reclassification of BI-RADS lesions may achieve a reduction in benign biopsies in BI-RADS 4-5 lesions without sacrificing sensitivity unacceptably. CLINICAL RELEVANCE STATEMENT Combining 2D + 3D SWE with US effectively reduces benign biopsies in breast lesions with categories 4-5, potentially improving diagnostic accuracy of BI-RADS assessment for patients with breast lesions. TRIAL REGISTRATION ChiCTR1900026556 KEY POINTS: • Reduce benign biopsy is necessary in breast lesions with BI-RADS 4-5 category. • A reduction of 54.1% on benign biopsies in BI-RADS 4-5 lesions was achieved using 2D + 3D SWE reclassification. • Adding 2D + 3D SWE to standard breast US improved the diagnostic performance of BI-RADS assessment on breast lesions: specificity increased from 54 to 79%, and PPV increased from 54 to 71%, with slight loss in sensitivity (97.2% versus 98.7%) and NPV (98.1% versus 98.7%).
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Affiliation(s)
- Jinshun Xu
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Ultrasound Medicine & Laboratory of Translational Research in Ultrasound Theranostics, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Zhang
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wen Wen
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yushuang He
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Tianci Wei
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yanling Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaofang Pan
- Health Medical Department, Dalian Municipal Central Hospital, Dalian, China
| | - Yuhong Li
- Department of Ultrasound, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Yiyun Wu
- Department of Ultrasound, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Fenglin Dong
- Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Heqing Zhang
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hongchun Xu
- Department of Ultrasound, Shengjing-Dalian Hospital, Chinese Medical Sciences University, Dalian, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lingyun Bao
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinguo Zhang
- Department of Ultrasound, Shaoyang Central Hospital, Shaoyang, China
| | - Shichu Tang
- Department of Ultrasound, Hunan Provincial Tumor Hospital, Changsha, China
| | - Jintang Liao
- Department of Ultrasound, Xiangya Hospital of Central South University, Changsha, China
| | - Honghao Luo
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Haina Zhao
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jiawei Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Yulan Peng
- Department of Ultrasound Medicine, Institute of Ultrasound Medicine, West China Hospital of Sichuan University, Chengdu, China.
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