Second-Look Ultrasound Using Shear-Wave Elastography in MRI-Suspected Locoregional Recurrence of Breast Carcinoma

Purpose To investigate if second-look US using shear-wave elastography (SWE) can help to differentiate between benign and malignant changes in the postoperative breast after surgical treatment of breast carcinoma. Materials and Methods SWE and related sonographic features were reviewed in 90 female patients with a history of surgical treatment of breast carcinoma and a suspicious lesion detected on a follow-up MRI scan. A single experienced radiologist performed all second-look US exams with SWE measurements placing a circular region of interest measuring 2mm in diameter over the stiffest part of the lesion. Tissue samples for histopathological analysis were obtained during the same US examination via core-needle biopsy. Results Out of 90 lesions, 39 were proven malignant on histopathological analysis. 50 % of malignant lesions had El(max) values ranging from 128 to 199 kPa, and 50 % of benign lesions had Elmax values ranging from 65 to 169 kPa. The cutoff value of 171.2 kPa for El(max) shows a sensitivity of 59 % and specificity of 78.4 % for carcinoma recurrence, area under the curve 0.706 (CI95 % 0.6-0.81), P = 0.001. In univariate logistic models, restricted diffusion and stiffness on SWE, El(max) > 171.2 kPa, were shown as significant recurrence predictors. In the multivariate model, restricted diffusion remains significant independent recurrence predictor. With a recurrence prevalence of 43 %, the test sensitivity is 95 % (CI95 % 8199 %) and the specificity is 75 % (CI95 % 60-85 %). Conclusion Stiffer lesions should be considered suspicious on second-look US in the postoperative breast and SWE can be a helpful tool in identifying malignant lesions, especially if this is related to restricted diffusion on MRI exam. Lesion stiffness, however, should not be considered as an independent predictor of lesion malignancy in the postoperative breast, because of benign changes that can appear stiff on SWE, as well as carcinoma recurrences that may appear soft.