The Accuracy of Ultrasound Elastography Versus Histopathology in Differentiation between Malignant and Benign Breast Masses

  • Riyadh W. Alessawi Department of Radiology, Faculty of Medicine, University of Kufa, Najaf, Iraq.
  • Salam Jasim Department of Community Medicine, Faculty of Medicine, University of Kufa, Najaf, Iraq.
  • Jinan Shumkhi Al khazali


Objective: The aim of this study was to evaluate the clinical value of ultrasound elastography (USE) in differentiating benign from malignant breast masses.
Methods: The study was conducted from January to August 2016 at Al Sader Medical City in Al Najaf, a total of 62 female patients. Each patient examined by B-mode US and those confirmed to have a breast mass were then assessed with strain elastography. A single ultrasound machine was used which was (VOLUSON E6, GE Austrian), and a linear probe was used to obtain the B-mode and elastography strain images.
Results: Forty one breast masses on strain elastography had ≥ 2.72 SR, 37masses were proved to be malignant on histopathological examination and 4 were false positive proved to be benign masses.
The study showed that the SR had Sensitivity=92.5%, Specificity =81.8%, PPV=90.2%, NPV=85.7%, with total Accuracy=88.7%.
There was a significant difference (P<0.001) between the mean values of SR of malignant and benign masses, for the malignant masses it was 3.97 ± 1.47 while for benign masses it was 2.34 ± 0.88.
According to the Tsukuba elasticity score, the elastogram score had Sensitivity=95%, Specificity=86.4%, PPV=92.7%, NPV=90.5% and the total accuracy = 91.9%.
Conclusion: The present study allows for the conclusion that Sonoelastography presents a good diagnostic sensitivity (92.5%) and high diagnostic specificity (81.8%) in the differentiation between benign and malignant lesions, thus allowing for a reduction in the current number of breast biopsies.
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1. El-Wakeel H, Umpleby HC. Systematic review of fibroadenoma as a risk factor for breast cancer. Breast 2003; 12:302–307.
2.Eberl MM, Fox CH, Edge SB,Carter CA, Mahoney MC. BI-RADS classification for management of abnormal mammograms. The Journal of the American Board of Family Medicine. 2006 Mar-Apr;19(2):161-4.
3.Sandrin L, Tanter M, Gennisson JL, Catheline S, Fink M. Shear elasticity probe for soft tissues with 1-D transient elastography.IEEE Trans Ultrason Ferro electr Freq Control. 2002 Apr;49(4):436-46.
4.Latorre-Ossa H, Gennisson JL, De Brosses E, Tanter M. Quantitative imaging of nonlinear shear modulus by combining static elastography and shear wave elastography. IEEE Trans Ultrason Ferro electr Freq Control. 2012 Apr;59(4):833-9.
5.L. Hegedus. “Clinical practice. The thyroid nodule, "The NewEngland Journal of Medicine, 2004; vol. 351, pp. 1764–1771
6.Jonathan Frederik Carlsen et al. Accuracy of Visual Scoring and Semi-Quantification of Ultrasound Strain Elastography – A Phantom Study.PLoS 2014; 9.
7.Kathy Nightingale. Acoustic Radiation Force Impulse (ARFI) Imaging: A Review. Curr Med Imaging Rev. 2011 Nov 1; 7(4): 328–339.

8. Destounis, S, Arieno, A, Skolny, M, Morgan, R, Somerville, P, Murphy, P, Seifert, P, Young, W, et al. The Role of Elasticity Imaging (EI) in a Large Community-based Breast Imaging Center. Breast imaging. 2009; 51;11-15
9.Zhi H, Xiao XY, Yang HY, et al. Semi-quantitating stiffness of breast solidlesions in ultrasonic elastography. Acad Radiol 2008; 15:1347–1353.
10.Lee AH. Why is carcinoma of the breast more frequent in the upper outer quadrant? A case series based on needle core biopsy diagnoses.Breast. 2005 Apr;14(2):151-2.
11.Daniel Wayne W. Biostatistic a foundation for analysis in the health science.8th edition (2010).
12.Athanasiou A, Tardivon A, Tanter M, et al. Breast lesions: quantitative elastography with supersonic shear imaging—preliminary results.Radiology. 2010;256(1):297-303.
13.Goddi A., Sacchi A., Magistretti G., Almolla J. Transrectal real-time elastography of the prostate:normal patterns.J Ultrasound 2011; 14:220–232.
14.Itoh A, Ueno E, Tohno E, et al. Breast disease: clinical application of USelastography for diagnosis. Radiology2006; 239:341–350.
How to Cite
ALESSAWI, Riyadh W.; JASIM, Salam; AL KHAZALI, Jinan Shumkhi. The Accuracy of Ultrasound Elastography Versus Histopathology in Differentiation between Malignant and Benign Breast Masses. Iraq Medical Journal, [S.l.], v. 2, n. 4, dec. 2018. ISSN 2521-8492. Available at: <>. Date accessed: 19 may 2019.