ROLE OF ELASTOGRAPHY IN EVALUATING BREAST LESIONS: A COMPARATIVE STUDY OF STRAIN AND SHEAR WAVE ELASTOGRAPHY WITH PATHOLOGICAL CORRELATION

Abstract

Background: Breast diseases affect millions of women worldwide, with breast cancer being the leading cause of cancer-related mortality among women. Characterization of breast lesions as benign or malignant is crucial for appropriate management. Ultrasound elastography is an emerging non-invasive imaging technique that evaluates tissue stiffness, providing additional information beyond conventional B-mode ultrasound. Aim: To assess the role of elastography as an adjunct to conventional ultrasound in differentiating benign and malignant breast lesions, and to compare the advantages and limitations of strain and shear wave elastography techniques. Materials and Methods: A prospective cross-sectional study was conducted over 18 months in the Department of Radio Diagnosis at B.L.D.E.U's Shri B. M. Patil Medical College, Vijaypur. A total of 47 patients with ultrasonographically detectable breast lesions were evaluated using B-mode ultrasound, strain elastography (elastography scoring and strain ratio), and shear wave elastography. Findings were correlated with pathological results (FNAC/histopathology). Results: Of the 47 lesions, 30 (64%) were benign and 17 (36%) were malignant. Fibroadenoma was the most common benign lesion, while invasive ductal carcinoma was the most common malignancy. Strain elastography scoring demonstrated sensitivity of 100%, specificity of 88%, PPV of 94%, and NPV of 100%. Strain ratio showed sensitivity of 97%, specificity of 88%, PPV of 94%, and NPV of 94%. Shear wave elastography demonstrated sensitivity of 100%, specificity of 94%, PPV of 97%, and NPV of 100%. All elastography techniques showed statistically significant correlation with pathological outcomes (p<0.0001). The area under the ROC curve for shear wave elastography (0.971) was slightly higher than strain elastography scoring (0.941) and strain ratio (0.925). Conclusion: Ultrasound elastography is a valuable adjunct to conventional B-mode ultrasound in the evaluation of breast lesions. Both strain and shear wave elastography techniques improve diagnostic accuracy in differentiating benign from malignant breast lesions, with shear wave elastography showing marginally better performance. Elastography has the potential to reduce unnecessary biopsies in breast lesions.