Qualitative pattern classification of shear wave elastography for breast masses: How it correlates to quantitative measurements

Objective: To determine the correlation of qualitative shear wave elastography (SWE) pattern classification to quantitative SWE measurements and whether it is representative of quantitative SWE values with similar performances. Methods: From October 2012 to January 2013, 267 breast masses of 236 women (mean age: 45.12 ± 10.54 years, range: 21–88 years) who had undergone ultrasonography (US), SWE, and subsequent biopsy were included. US BI-RADS final assessment and qualitative and quantitative SWE measurements were recorded. Correlation between pattern classification and mean elasticity, maximum elasticity, elasticity ratio and standard deviation were evaluated. Diagnostic performances of grayscale US, SWE parameters, and US combined to SWE values were calculated and compared. Results: Of the 267 breast masses, 208 (77.9%) were benign and 59 (22.1%) were malignant. Pattern classifications significantly correlated with all quantitative SWE measurements, showing highest correlation with maximum elasticity, r = 0.721 (P < 0.001). Sensitivity was significantly decreased in US combined to SWE measurements to grayscale US: 69.5–89.8% to 100.0%, while specificity was significantly improved: 62.5–81.7% to 13.9% (P < 0.001). Area under the ROC curve (A_z) did not show significant differences between grayscale US to US combined to SWE (P > 0.05). Conclusion: Pattern classification shows high correlation to maximum stiffness and may be representative of quantitative SWE values. When combined to grayscale US, SWE improves specificity of US