The Role of Elastography in Reducing Unnecessary Biopsies in BI-RADS 4a and 4b Breast Lesions

Many benign breast lesions in the Breast Imaging Reporting and Data System (BI-RADS) 4 category defined by ultrasonography (US) undergo unnecessary biopsies. This study aims to investigate the efficiency of acoustic radiation for impulse elastography (ARFI) in diagnosing BI-RADS 4 breast lesions. The ARFI elastography technique was utilized to assess the lesions both qualitatively and quantitatively. By using quantitative elastography measurement, we found that the shear wave velocity (SWV) of BI-RADS 4a lesions was significantly lower compared to the SWV of BI-RADS 4b and 4c lesions (p = 0.00). In qualitative evaluation, pattern 1 only defined benign lesions, and a negative predictive value (NPV) of 100% was obtained. Using quantitative, qualitative and combined methods, the Likelihood ratios was determined to be 1.81, 2.8 and 4.7 respectively. In addition to the ultrasound examination of BI-RADS 4 lesions, the addition of combined elastography assessment increases the accuracy of BI-RADS. BI-RADS 4a lesions can be followed in a similar way as BI-RADS 3 lesions.