Ultrasound strain elastography to improve diagnostic performance of breast lesions by reclassifying BI-RADS 3 and 4a lesions: a multicentre diagnostic study

Yang Gu; Jiawei Tian; Haitao Ran; Weidong Ren; Cai Chang; Jianjun Yuan; Chunsong Kang; Youbin Deng; Hui Wang; Baoming Luo; Shenglan Guo; Qi Zhou; Ensheng Xue; Weiwei Zhan; Qing Zhou; Jie Li; Ping Zhou; Chunquan Zhang; Man Chen; Ying Gu; Jinfeng Xu; Wu Chen; Yuhong Zhang; Jianchu Li; Hongyan Wang; Yuxin Jiang

doi:10.1093/bjr/tqae197

Ultrasound strain elastography to improve diagnostic performance of breast lesions by reclassifying BI-RADS 3 and 4a lesions: a multicentre diagnostic study

Br J Radiol. 2025 Jan 1;98(1165):89-99. doi: 10.1093/bjr/tqae197.

Authors

Yang Gu^{1

2}, Jiawei Tian³, Haitao Ran⁴, Weidong Ren⁵, Cai Chang⁶, Jianjun Yuan⁷, Chunsong Kang⁸, Youbin Deng⁹, Hui Wang¹⁰, Baoming Luo¹¹, Shenglan Guo¹², Qi Zhou¹³, Ensheng Xue¹⁴, Weiwei Zhan¹⁵, Qing Zhou¹⁶, Jie Li¹⁷, Ping Zhou¹⁸, Chunquan Zhang¹⁹, Man Chen²⁰, Ying Gu²¹, Jinfeng Xu²², Wu Chen²³, Yuhong Zhang²⁴, Jianchu Li¹, Hongyan Wang¹, Yuxin Jiang¹

Affiliations

¹ Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
² Department of Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou 215000, China.
³ Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
⁴ Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University & Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China.
⁵ Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, China.
⁶ Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
⁷ Department of Ultrasonography, Henan Provincial People's Hospital, Zhengzhou 450003, China.
⁸ Department of Ultrasound, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, China.
⁹ Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China.
¹⁰ Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun130033, China.
¹¹ Department of Ultrasound, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
¹² Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China.
¹³ Department of Medical Ultrasound, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, China.
¹⁴ Department of Ultrasound, Union Hospital of Fujian Medical University, Fujian Institute of Ultrasound Medicine, Fuzhou 350001, China.
¹⁵ Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China.
¹⁶ Department of Ultrasonography, Renmin Hospital of Wuhan University, Wuhan 430060, China.
¹⁷ Department of Ultrasound, Qilu Hospital, Shandong University, Jinan 250012, China.
¹⁸ Department of Ultrasound, The Third Xiangya Hospital of Central South University, Changsha 410013, China.
¹⁹ Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.
²⁰ Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
²¹ Department of Ultrasonography, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China.
²² Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen 518020, China.
²³ Department of Ultrasound, The First Hospital of Shanxi Medical University, Taiyuan 030001, China.
²⁴ Department of Ultrasound, The Second Hospital of Dalian Medical University, Dalian 116027, China.

PMID: 39388198
DOI: 10.1093/bjr/tqae197

Abstract

Objectives: To investigate the added value of strain elastography (SE) by recategorizing ultrasound (US) breast imaging reporting and data system (BI-RADS) 3 and 4a lesions.

Methods: A total of 4371 patients underwent US and SE with BI-RADS 2-5 categories solid breast lesions were included from 32 hospitals. We evaluated the elastographic images according to elasticity scores (ES) and strain ratios (SR). Three combined methods (BI-RADS + ES, BI-RADS + SR, BI-RADS + ES + SR) and two reclassified methods were used (method one: upgrading BI-RADS 3 and downgrading BI-RADS 4a, method two: downgrading BI-RADS 4a alone). The diagnostic performance and the potential reduction of unnecessary biopsies were evaluated.

Results: Combining BI-RADS with SE had a higher area under the curve (AUC) than BI-RADS alone (0.822-0.898 vs 0.794, P < .01). For reclassified method one, the sensitivity, specificity, and accuracy were 99.36%, 66.70%, 78.36% for BI-RADS + ES and 98.01%, 66.45%, 77.72% for BI-RADS + SR, and 99.42%, 66.70%, 78.38% for BI-RADS + ES + SR, respectively. For reclassified method two, the sensitivity, specificity, and accuracy were 99.17%, 70.72%, 80.87% for BI-RADS + ES and 97.76%, 81.75%, 87.46% for BI-RADS + SR, and 99.23%, 69.83%, 80.32% for BI-RADS + ES + SR, respectively. Downgrading BI-RADS 4a alone had higher AUC, specificity, and accuracy (P < .01) and similar sensitivity (P > .05) to upgrading BI-RADS 3 and downgrading BI-RADS 4a. Combining SE with BI-RADS could help reduce unnecessary biopsies by 17.64%-55.20%.

Conclusions: Combining BI-RADS with SE improved the diagnostic performance in distinguishing benign from malignant lesions and could decrease false-positive breast biopsy rates. Downgrading BI-RADS 4a lesions alone might be sufficient for achieving good diagnostic performance.

Advances in knowledge: Downgrading BI-RADS category 4a lesions alone had higher AUC, specificity, and accuracy, and similar sensitivity to upgrading or downgrading BI-RADS category 3 and 4a lesions.

Keywords: BI-RADS; breast neoplasms; strain elastography; ultrasonography.

Publication types

Multicenter Study

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Breast / diagnostic imaging
Breast Neoplasms* / diagnostic imaging
Elasticity Imaging Techniques* / methods
Female
Humans
Middle Aged
Retrospective Studies
Sensitivity and Specificity*
Ultrasonography, Mammary* / methods
Young Adult

Abstract

Publication types

MeSH terms

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