Value of Shear Wave Elastography in Discriminating Category IV Breast Lesions According to Breast Imaging-Reporting and Data System

Background: Breast cancer is the second cause of cancer death in women. Shear wave elastography (SWE) is an ultrasound (US) procedure that can improves the sensitivity and the specificity in the diagnosis of breast lesions. Objectives: To evaluate the value of SWE to discriminate benign from malignant Breast Imaging-Reporting and Data System (BI-RADS) IV breast lesions. Materials and methods: A cross sectional analytic study was done in the Radiology Department, Oncology Teaching Hospital, Baghdad Medical City, Baghdad, Iraq. The study period was one year (February 2020 to January 2021). The study included 42 female patients with suspicious breast lesions in the group BI-RAD 4 by mammography and US. Shear wave elastography was done for all patients. The final diagnosis of all breast lesions were done by fine needle aspiration cytology or true cut biopsy or excisional biopsy. Results: The final histological diagnosis showed that 23 (54.8%) of study patients were with benign breast lesions. There was a statistically significant association between the quality of SWE and histopathological diagnosis as the proportion of malignant breast lesions was significantly higher among the patients with score 5 (homogenous dark blue) images (85.7%, P= 0.004). Subjectts with malignant lesions had a significantly higher mean of E-mean SWV than those with benign lesions (133.8 versus 75.47 kPa, P = 0.001). The best cut point of E-mean SWV was 83 kPa (E-mean SWV > 83 kPa is predictive for malignant lesion of breast) with 89.5% sensitivity, 60.9% specificity, and 73.8% accuracy. Conclusion: SWE have a significant diagnostic value in differentiation of BI-RADS IV breast lesions into benign and malignant in both qualitative and quantitative patterns. The best cut off value in SWE is 83 KPa for E-mean.