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      Shear wave elastography for breast masses is highly reproducible

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          To evaluate intra- and interobserver reproducibility of shear wave elastography (SWE) for breast masses.


          For intraobserver reproducibility, each observer obtained three consecutive SWE images of 758 masses that were visible on ultrasound. 144 (19%) were malignant. Weighted kappa was used to assess the agreement of qualitative elastographic features; the reliability of quantitative measurements was assessed by intraclass correlation coefficients (ICC). For the interobserver reproducibility, a blinded observer reviewed images and agreement on features was determined.


          Mean age was 50 years; mean mass size was 13 mm. Qualitatively, SWE images were at least reasonably similar for 666/758 (87.9%). Intraclass correlation for SWE diameter, area and perimeter was almost perfect (ICC ≥ 0.94). Intraobserver reliability for maximum and mean elasticity was almost perfect (ICC = 0.84 and 0.87) and was substantial for the ratio of mass-to-fat elasticity (ICC = 0.77). Interobserver agreement was moderate for SWE homogeneity (κ = 0.57), substantial for qualitative colour assessment of maximum elasticity (κ = 0.66), fair for SWE shape (κ = 0.40), fair for B-mode mass margins (κ = 0.38), and moderate for B-mode mass shape (κ = 0.58), orientation (κ = 0.53) and BI-RADS assessment (κ = 0.59).


          SWE is highly reproducible for assessing elastographic features of breast masses within and across observers. SWE interpretation is at least as consistent as that of BI-RADS ultrasound B-mode features.

          Key Points

          Shear wave ultrasound elastography can measure the stiffness of breast tissue

          It provides a qualitatively and quantitatively interpretable colour-coded map of tissue stiffness

          Intraobserver reproducibility of SWE is almost perfect while intraobserver reproducibility of SWE proved to be moderate to substantial

          The most reproducible SWE features between observers were SWE image homogeneity and maximum elasticity

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          Most cited references 15

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          An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers.

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            The Equivalence of Weighted Kappa and the Intraclass Correlation Coefficient as Measures of Reliability

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              Breast disease: clinical application of US elastography for diagnosis.

              To evaluate the diagnostic performance of real-time freehand elastography by using the extended combined autocorrelation method (CAM) to differentiate benign from malignant breast lesions, with pathologic diagnosis as the reference standard. This study was approved by the University of Tsukuba Human Subjects Institutional Review Board; all patients gave informed consent. Conventional ultrasonography (US) and real-time US elastography with CAM were performed in 111 women (mean age, 49.4 years; age range, 27-91 years) who had breast lesions (59 benign, 52 malignant). Elasticity images were assigned an elasticity score according to the degree and distribution of strain induced by light compression. The area under the curve and cutoff point, both of which were obtained by using a receiver operating characteristic curve analysis, were used to assess diagnostic performance. Mean scores were examined by using a Student t test. Sensitivity, specificity, and accuracy were compared by using the standard proportion difference test or the Delta-equivalent test. For elasticity score, the mean +/- standard deviation was 4.2 +/- 0.9 for malignant lesions and 2.1 +/- 1.0 for benign lesions (P < .001). When a cutoff point of between 3 and 4 was used, elastography had 86.5% sensitivity, 89.8% specificity, and 88.3% accuracy. When a best cutoff point of between 4 and 5 was used, conventional US had 71.2% sensitivity, 96.6% specificity, and 84.7% accuracy. Elastography had higher sensitivity than conventional US (P < .05). By using equivalence bands for noninferiority or equivalence, it was shown that the specificity of elastography was not inferior to that of conventional US and that the accuracy of elastography was equivalent to that of conventional US. For assessing breast lesions, US elastography with the proposed imaging classification, which was simple compared with that of the Breast Imaging Recording and Data System classification, had almost the same diagnostic performance as conventional US. (c) RSNA, 2006.

                Author and article information

                +44-208-3834942 , +44-208-7345409 ,
                Eur Radiol
                Eur Radiol
                European Radiology
                Springer-Verlag (Berlin/Heidelberg )
                31 December 2011
                31 December 2011
                May 2012
                : 22
                : 5
                : 1023-1032
                [1 ]Imperial College, Hammersmith Campus, London, UK
                [2 ]Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
                [3 ]MRC Clinical Trials Unit, London, UK
                [4 ]SuperSonic Imagine, Aix en Provence, France
                [5 ]Imaging Sciences Department, Imperial College, Hammersmith Hospital, Du Cane Road, London, W12 0HS UK
                © The Author(s) 2011
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                © European Society of Radiology 2012


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