Evaluation of elastography in breast nodules

comparison between quantitative and semi-quantitative techniques

Abstract

INTRODUCTION: Since its introduction into clinical practice in the 1970s, ultrasound has been a crucial tool for medical diagnostics. Continuous developments, such as Doppler and elastography, have provided new ways of non-invasive assessment of tissue properties. Elastography, in particular, uses changes in tissue elasticity to offer qualitative and quantitative information for diagnosis. It is of special interest due to its wide availability and relatively low cost. OBJECTIVE: This study reviews the ultrasound elastography technique, exploring its potential applications in differentiating benign and malignant breast lesions, as well as its limitations. METHODS: The study is a narrative review of the available literature on breast elastography, analyzing studies that investigated the effectiveness of this technique in characterizing breast lesions. Different scoring systems, criteria, and evaluation methods of elastography are considered, as well as studies that use both strain elastography (SE) and shear wave elastography (SWE) to assess breast lesions. RESULTS: Breast elastography has proven effective in differentiating between benign and malignant lesions, particularly in cases of indeterminate lesions on conventional ultrasound. The combination of conventional ultrasound with elastography, along with semi-quantitative analyses, has shown significant improvements in diagnostic accuracy. DISCUSSION: Despite its effectiveness, elastography faces some technical limitations, such as the lack of uniformity in commercial systems and the subjectivity in measurements. However, its promising clinical potential makes it an active area of research in various medical fields. CONCLUSION: Breast elastography is a useful tool in differentiating between benign and malignant breast lesions, especially in cases of indeterminate lesions on conventional ultrasound. The combination with conventional ultrasound and semi-quantitative analysis can significantly improve diagnostic accuracy. However, elastography may have limitations in lesions classified as BI-RADS 4, and the decision to perform a biopsy should still be based on a comprehensive clinical evaluation.