The Role of Elastography in Differentiating Benign and Malignant Breast Lesions
DOI:
https://doi.org/10.12775/JEHS.2025.79.58414Keywords
elastography, breast lesions, benign breast lesions, malignant breast lesions, shear-wave elastohraphy, strain elastography, breast cancer diagnosis, ultrasound imaging, diagnostic imaging, breast cancer screening, non-invasive diagnostics, imaging sensivity, imaging specifity, tissue elasticity, advanced ultrasound techniquesAbstract
Background: The differential diagnosis of benign and malignant breast lesions is a significant challenge in radiology. Traditional imaging modalities such as ultrasonography (USG) and mammography, despite their widespread use, have limitations in accurately differentiating tissues. Elastography, a modern ultrasound imaging technique, enables the assessment of biomechanical properties of tissues, such as hardness and elasticity, offering new possibilities in breast cancer diagnosis.
Objective: The aim of this study is to review the literature on the use of elastography in the diagnosis of breast lesions, with a focus on its effectiveness in differentiating benign and malignant lesions. Different elastographic techniques, their diagnostic parameters and their benefits and limitations compared to traditional imaging modalities are discussed.
Methods: The analysis was based on the available scientific literature published in the last 20 years, searching databases such as PubMed, Scopus and Web of Science. Studies evaluating the effectiveness of elastography (strain and shear-wave) in breast cancer diagnosis and its application in clinical practice were included.
Results and conclusions: Elastography demonstrates high diagnostic efficacy, achieving sensitivity and specificity comparable to or superior to traditional ultrasound. Due to its ability to non-invasively assess tissue hardness, elastography can reduce the number of unnecessary biopsies. However, the literature review indicates some limitations, such as operator dependence and differences in results obtained with different devices. Further studies, especially multi-centre studies, are needed to standardise diagnostic standards.
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.
Nowicki A, Markowska J, Ziółkowska E. Breast cancer epidemiology in Poland and Europe – current status and challenges. Nowotwory. J Oncol. 2021;71(2):93–103. https://doi.org/10.5603/NJO.2021.0017.
Zhi H, Ou B, Luo BM, et al. Elastography in the assessment of breast lesions: added value and limitations—a systematic review. Eur J Radiol. 2010;77(1):119–27. https://doi.org/10.1016/j.ejrad.2009.06.032.
Tabár L, Yen MF, Vitak B, Chen HH, Smith RA, Duffy SW. Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet. 2003;361(9367):1405–10. https://doi.org/10.1016/S0140-6736(03)13143-1.
Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, et al. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology. 2004;233(3):830–49. https://doi.org/10.1148/radiol.2333031484.
Cosgrove DO, Berg WA, Doré CJ, Skyba DM, Henry JP, Gay J, et al. Shear wave elastography for breast masses is highly reproducible. Eur Radiol. 2012;22(5):1023–32. https://doi.org/10.1007/s00330-011-2340-y.
Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356(3):227–36. https://doi.org/10.1056/NEJMoa062790.
Lee SH, Chang JM, Kim WH, Bae MS, Cho N, Yi A, et al. Added value of shear-wave elastographic features in differentiation between benign and malignant breast masses at ultrasound. Radiology. 2014;273(1):61–9. https://doi.org/10.1148/radiol.14132035.
Chang JM, Moon WK, Cho N, et al. Shear-wave elastography for breast masses: highly reproducible results in benign and malignant lesions. Radiology. 2012;262(2):344–353. https://doi.org/10.1148/radiol.11110264.
Yoon JH, Ko KH, Jung HK, et al. Diagnostic performance of strain ratio measurement in breast ultrasound elastography. Ultrasound Med Biol. 2014;40(10):2340–9. https://doi.org/10.1016/j.ultrasmedbio.2014.06.006.
Itoh A, Ueno E, Tohno E, et al. Real-time elastography in the evaluation of breast masses: a prospective multicenter study. J Ultrasound Med. 2006;25(1):83–9. https://doi.org/10.7863/jum.2006.25.1.83.
Thomas A, Degenhardt F, Farrokh A, et al. Elastography – new tools in ultrasound. Breast Cancer Res. 2010;12(Suppl 3):S5. https://doi.org/10.1186/bcr2486.
Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound elastography: Review of techniques and clinical applications. Theranostics. 2017;7(5):1303–29. https://doi.org/10.7150/thno.18650.
Barr RG. Elastography in breast imaging: State of the art. J Ultrasound Med. 2013;32(2):217–25. https://doi.org/10.7863/jum.2013.32.2.217.
Garra BS, Cespedes EI, Ophir J, Spratt SR, Zuurbier RA, Magnant CM, et al. Elastography of breast lesions: initial clinical results. Radiology. 1997;202(1):79–86. https://doi.org/10.1148/radiology.202.1.8988195.
Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13(2):111–34. https://doi.org/10.1177/016173469101300201.
Gheonea DI, Stoica Z, Bondari S. Differential diagnosis of breast lesions using ultrasound elastography. Med Ultrason. 2011;13(1):23-30. https://doi.org/10.11152/mu.2011.2066.131.diagn.
Goddi A, Bonardi M, Alessi S. Breast elastography: A literature review. J Ultrasound. 2012;15(3):192-198. https://doi.org/10.1016/j.jus.2012.07.003.
Balleyguier C, Ciolovan LM, Brustel C, et al. Breast elastography: The technical process and clinical applications. Radiol Clin North Am. 2013;51(6):1089-1102. https://doi.org/10.1016/j.rcl.2013.09.007.
Itoh A, Ueno E, Tohno E, et al. Breast disease: Clinical application of US elastography for diagnosis. Radiology.2006;239(2):341-350. https://doi.org/10.1148/radiol.2392041748.
Chang JM, Won JK, Lee KB, et al. Comparison of shear-wave and strain elastography in the differentiation of benign and malignant breast lesions. AJR Am J Roentgenol. 2013;201(2):W347-W356. https://doi.org/10.2214/AJR.12.9566.
Barr RG, Zhang Z. Shear wave elastography of the breast: Value of a quality measure and comparison with strain elastography. Radiology. 2015;275(1):45–53. https://doi.org/10.1148/radiol.14140345.
Berg WA, Cosgrove DO, Doré CJ, Schäfer FK, Svensson WE, Hooley RJ, et al. Shear-wave elastography improves the specificity of breast US: The BE1 multinational study of 939 masses. Radiology. 2012;262(2):435–49. https://doi.org/10.1148/radiol.11110640.
Lee SH, Chang JM, Kim WH, et al. Shear-wave elastography for the diagnosis of small breast cancers: Efficacy with a new quantification method using color overlay. AJR Am J Roentgenol. 2014;203(3):W308-W318. https://doi.org/10.2214/AJR.13.11755.
Skerl K, Vinnicombe SJ, Giannotti E, et al. The role of ultrasound strain imaging in predicting malignancy in breast lesions: A prospective study. Clin Radiol. 2011;66(12):1085-1093. https://doi.org/10.1016/j.crad.2011.08.004.
Schnall MD, Blume J, Bluemke DA, DeAngelis GA, DeBruhl N, Harms S, et al. Diagnostic architectural and dynamic features at breast MR imaging: Multicenter study. Radiology. 2006;238(1):42–53. https://doi.org/10.1148/radiol.2381050893.
Chang JM, Moon WK, Cho N, Kim SJ, Moon A, Kim EK. Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Ultrasound Med Biol. 2010;36(3):453–61. https://doi.org/10.1016/j.ultrasmedbio.2009.09.011.
Barr RG, Zhang Z. Effects of precompression on elasticity imaging of the breast: development of a clinically useful semiquantitative method of precompression assessment. J Ultrasound Med. 2012;31(6):895–902. https://doi.org/10.7863/jum.2012.31.6.895.
Moon WK, Cho N, Chang JM, Im JG. Elastography for breast lesions: Recommendations for clinical use. Clin Imaging. 2013;38(5):510–5. https://doi.org/10.1016/j.clinimag.2013.06.001.
Cho N, Moon WK, Park JS, Cha JH, Jang M, Seong MH. Shear wave elastography for the diagnostic performance of breast lesions: analysis of interobserver variability. J Ultrasound Med. 2014;33(3):457–64. https://doi.org/10.7863/ultra.33.3.457.
Evans A, Whelehan P, Thomson K, McLean D, Brauer K, Purdie C, et al. Quantitative shear wave ultrasound elastography: initial experience in solid breast masses. Breast Cancer Res. 2010;12(6):R104. https://doi.org/10.1186/bcr2787.
Thomas A, Degenhardt F, Farrokh A, et al. Significant differentiation of focal breast lesions: raw data analysis of strain pattern in breast elastography. Ultrasound Med Biol. 2010;36(9):1376–1383. https://doi.org/10.1016/j.ultrasmedbio.2010.06.001.
Oncology Imaging Journal. Elastography limitations in breast ultrasound. Oncol Imaging J. 2012;5(2):45–50. https://doi.org/10.1016/j.oncolimg.2012.05.045.
Barr RG. Sonographic breast elastography: a primer. J Ultrasound Med. 2012;31(5):773–783. https://doi.org/10.7863/jum.2012.31.5.773.
Muthupillai R, Ehman RL. Magnetic resonance elastography. Nat Med. 1996;2(5):601-603. https://doi.org/ 10.1038/nm0596-601.
Leening MJ, Kim ES, Schindler TH. Artificial intelligence in elastography: challenges and opportunities. J Ultrasound Med. 2021;40(8):1653-1661. https://doi.org/ 10.7863/jum.2021.40.8.1653.
Evans A, Whelehan P, Thomson K, et al. Invasive breast cancer: relationship between shear-wave elastographic findings and histologic prognostic factors. Radiology. 2012;263(3):673-677. Https://doi.org/ 10.1148/radiol.12110744.
Barr RG. Elastography in the diagnosis of breast disease: a review. J Breast Imaging. 2020;2(2):104-115. Https://doi.org/ 10.1093/jbi/wbaa011.
Sarvazyan A, Rudenko O, Swanson SD, et al. Shear wave elasticity imaging: a new ultrasonic technology of medical diagnostics. Ultrasound Med Biol. 1998;24(9):1419-1435. https://doi.org/10.1016/S0301-5629(98)00110-0.
Nakashima K, Shiina T, Sakurai M, Enokido K, Endo T, Tsunoda H, et al. New developments in elastography for breast cancer and thyroid cancer. World J Clin Oncol. 2022;13(4):251–62. https://doi.org/10.5306/wjco.v13.i4.251.10.1186/bcr2787
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Copyright (c) 2025 Michał Wijata, Anna Wijata, Justyna Dutkiewicz, Zuzanna Adriana Przybyłek-Stępień, Ryszard Bartosiński, Jan Szustak, Wiktoria Mączyńska, Maria Kąpa, Bartosz Szepietowski, Jakub Kaźmierczak, Ewelina Rycerz
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