The diagnostic performance of shear-wave elastography combined with ultrasound and magnetic resonance imaging in breast lesions: A single center retrospective study.

Background: Breast cancer remains a major healthcare challenge, highlighting the need for early and accurate diagnosis. Shear-wave elastography (SWE), an ultrasound-based imaging technique that quantifies tissue elasticity, has emerged as a promising tool. Recent studies suggest that SWE may provide additional diagnostic value when used alongside conventional imaging methods.

Objectives: This study aimed to assess the diagnostic performance of SWE when combined with conventional ultrasound and magnetic resonance imaging (MRI) in the evaluation of breast lesions.

Material and methods: This retrospective study included patients with breast lesions who underwent SWE, conventional ultrasound and MRI. The diagnostic performance of each modality was evaluated individually and in combination. Histopathological results served as the gold standard for diagnosis. Key performance metrics - sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy - were calculated for each imaging approach.

Results: A total of 99 patients were included in the study, comprising 64 with benign lesions and 35 with malignant lesions. Malignant lesions were generally larger and exhibited distinct imaging characteristics across ultrasound, SWE and MRI. When assessed individually, SWE, ultrasound and MRI showed comparable diagnostic accuracy (64.6%, 62.6% and 62.6%, respectively). However, combining all 3 modalities significantly improved diagnostic performance, yielding sensitivity, specificity, PPV, NPV, and overall accuracy of 94.3%, 89.1%, 82.5%, 96.6%, and 90.9%, respectively (p < 0.001). The area under the curve (AUC) for the combined approach was significantly higher than for any single modality (0.917 vs 0.642, 0.627 and 0.633; p < 0.001).

Conclusions: While SWE alone offers diagnostic performance comparable to that of ultrasound and MRI individually, its greatest value lies in combination with these imaging modalities. Integrating ultrasound, SWE and MRI significantly enhances diagnostic accuracy, sensitivity and specificity, offering a promising multimodal approach for more reliable differentiation between benign and malignant breast lesions.