Ultrasound Elastography: Beyond Shades of Gray
Stacy Smith-Foley, MD
Breast Imaging Specialist
The Breast Center at CARTI
Little Rock, AR
In this CME presentation Dr. Smith-Foley will demonstrate the clinical utility of elastography ultrasound for benign and malignant breast lesions. Ultrasound elastography increases both the sensitivity and specificity when added to gray scale analysis. It can be used for biopsy guidance, to define extent of disease and for monitoring treatment response.
Upon completion of this lecture, participants will be able to:
1. Discuss the evolution of advanced ultrasound technology in breast imaging and review emerging data.
2. Describe the impact and utility of advanced ultrasound tools in clinical practice.
3. Review case examples of elastography in clinical practice.
Release Date: 2/15/2023
Expiration Date: 3/1/2026
CONFLICT OF INTEREST DISCLOSURE
FACULTY/PROGRAM PLANNING COMMITTEE MEMBERS
Stacy Smith-Foley, MD
Consultant & Speaker: Hologic, Inc., Myriad, Beekley Medical
All of the relevant financial relationships listed for these individuals have been mitigated by peer review completed by peers with no relevant financial relationships to disclose.
None of the other program directors/planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
World Class CME is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
World Class CME designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Credit may be used towards ABR MOC Part 2 SA-CME requirements
The American Society of Radiologic Technologists Credit has approved this activity as follows:
|Reference No.||Cat.||Activity Title||Start Date||Expires||Credit|
|NCZ02330017||A||Ultrasound Elastography: Beyond Shades of Gray||2/15/2023||3/1/2026||1|
This activity may be available in multiple formats or from different sponsors. A self-learning activity can be completed only once per biennium
World Class CME relies on its CME faculty to provide program content that is evidence-based and free of commercial bias. Therefore, in accordance with ACCME standards, any faculty, program director, reviewer and/or provider industry relationships will be disclosed and resolved. Speakers are required to openly disclose any limitations of data or any discussion of any off-label, experimental, or investigational uses of drugs or devices in their presentations.
This activity is supported by an unrestricted educational grant from Hologic, Inc.
Instructions to Receive Credit: After viewing the video, click on the “Take the Quiz” button and complete the post-activity quiz. After completing the quiz, fill out the evaluation form and submit. Your CME certificate will then be emailed to you
1-Berg WA, Gutierrez L, NessAiverMS, Carter WB, BhargavanM, Lewis RS, IoffeOB. Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 2004;233:830-8492-Mendelson EB, Böhm-VélezM, Berg WA, et al. ACR BI-RADS® Ultrasound. In: ACR BI-RADS® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2015.3-Parker SH, JobeWE, Dennis MA, Stavros AT, Johnson KK, YakesWF, TruellJE, Price JG, KortzAB, Clark DG. US-guided automated large-core breast biopsy. Radiology 1993;187:507-5114-Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Böhm-VélezM, Pisano ED, Jong RA, Evans WP, Morton MJ, Mahoney MC, Larsen LH, Barr RG, FarriaDM, Marques HS, Boparai K; ACRIN 6666 Investigators. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008 May 14;299(18):2151-63. doi: 10.1001/ jama.299.18.2151. Erratum in: JAMA. 2010 Apr 21;303(15):1482.5-Ohuchi N, Suzuki A, SobueT, Kawai M, Yamamoto S, Zheng YF, Shiono YN, Saito H, KuriyamaS, TohnoE, Endo T, FukaoA, Tsuji I, Yamaguchi T, Ohashi Y, Fukuda M, Ishida T; J-START investigator groups. Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomisedcontrolled trial. Lancet. 2016 Jan 23;387(10016):341-8.6-Lazarus E, MainieroMB, ScheppsB, KoellikerSL, Livingston LS. BI-RADS lexicon for US and mammography: interobserver variability and positive predictive value. Radiology 2006;239(2):385-391.7-Moorman AM, BourezRL, de Leeuw DM, Kouwenhoven EA. Pre-operative Ultrasonographic Evaluation of Axillary Lymph Nodes in Breast Cancer Patients: For Which Group Still of Additional Value and in Which Group Cause for Special Attention? Ultrasound Med Biol. 2015 Aug 7. pii: S0301-5629(15)00411-1. doi: 10.1016/j. ultrasmedbio.2015.06.0138-Barr RG, Zhang Z. Effects of precompression on elasticity imaging of the breast: development of a clinically useful semiquantitative method of precompression assessment. J Ultrasound Med. 2012 Jun;31(6):895-902.9-Cosgrove DO, Berg WA, DoréCJ, SkybaDM, Henry JP, Gay J, Cohen-BacrieC; BE1 Study Group. Shear wave elastography for breast masses is highly reproducible. Eur Radiol. 2012 May;22(5): 1023-32.10-Evans A, WhelehanP, Thomson K, BrauerK, Jordan L, Purdie C, McLean D, Baker L, VinnicombeS, Thompson A. Differentiating benign from malignant solid breast masses: value of shear wave elastography according to lesion stiffness combined with greyscale ultrasound according to BI-RADS classification. Br J Cancer. 2012 Jul 10;107(2):224-9.
Sources11-GweonHM, YoukJH, Son EJ, Kim JA. Clinical application of qualitative assessment for breast masses in shear-wave elastography. Eur J Radiol. 2013 Nov;82(11):e680-5.12-Kim H, YoukJH, GweonHM, Kim JA, Son EJ. Diagnostic performance of qualitative shear-wave elastography according to different color map opacities for breast masses. Eur J Radiol. 2013 Aug;82(8):e326-3113-Lee SH, Cho N, Chang JM, Koo HR, Kim JY, Kim WH, Bae MS, Yi A, Moon WK. Two-view versus single-view shear-wave elastography:comparison of observer performance in differentiating benign from malignant breast masses. Radiology. 2014 Feb;270(2):344-53.14-Youk JH, Son EJ, GweonHM, Kim H, Park YJ, Kim JA. Comparison of strain and shear wave elastography for the differentiation of benign from malignant breast lesions, combined with B-mode ultrasonography: qualitative and quantitative assessments. Ultrasound Med Biol. 2014 Oct;40(10):2336-44.15-Zhou J, Zhan W, Chang C, Zhang X, Jia Y, Dong Y, Zhou C, Sun J, Grant EG. Breast lesions: evaluation with shear wave elastography, with special emphasis on the “stiff rim” sign. Radiology. 2014 Jul;272(1):63-72.16-YoukJH, GweonHM, Son EJ, Chung J, Kim JA, Kim EK. Three dimensional shear-wave elastography for differentiating benign and malignant breast lesions: comparison with two-dimensional shear-wave elastography. Eur Radiol. 2013 Jun;23(6):1519-27.17-TozakiM, FukumaE. Pattern classification of ShearWave™ Elastography images for differential diagnosis between benign and malignant solid breast masses. Acta Radiol. 2011 Dec 1;52(10):1069-75.18-AthanasiouA, TardivonA, TanterM, Sigal-ZafraniB, BercoffJ, DeffieuxT, GennissonJL, Fink M, Neuenschwander S. Breast lesions: quantitative elastography with supersonic shear imaging--preliminary results. Radiology. 2010 Jul;256(1):297-303.19-RzymskiP, SkórzewskaA, Skibinska-ZielinskaM, OpalaT. Factors influencing breast elasticity measured by the ultrasound ShearWaveelastography -preliminary results. Arch Med Sci. 2011 Feb;7(1):127-3320-TanterM, BercoffJ, AthanasiouA, DeffieuxT, GennissonJL, MontaldoG, Muller M, TardivonA, Fink M. Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging. Ultrasound Med Biol. 2008 Sep;34(9):1373-8621-Au FW, GhaiS, MoshonovH, Kahn H, Brennan C, DuaH, Crystal P. Diagnostic performance of quantitative shear wave elastography in the evaluation of solid breast masses: determination of the most discriminatory parameter. AJR Am J Roentgenol. 2014 Sep;203(3):W328-36.22-Berg WA, Cosgrove DO, DoréCJ, Schäfer FK, SvenssonWE, Hooley RJ, OhlingerR, Mendelson EB, Balu-Maestro C, Locatelli M,TourasseC, Cavanaugh BC, JuhanV, Stavros AT, TardivonA, Gay J, Henry JP, Cohen-BacrieC; BE1 Investigators. Shearwaveelastography improves the specificity of breast US: the BE1 multinational study of 939 masses. Radiology. 2012 Feb;262(2):435-49.
Sources23-Berg WA, Mendelson EB, Cosgrove DO, DoréCJ, Gay J, Henry JP, Cohen-BacrieC. Quantitative Maximum Shear-Wave Stiffness of Breast Masses as a Predictor of Histopathologic Severity. AJR Am J Roentgenol. 2015 Aug;205(2):448-55.Chang, 201124-Chang JM, Moon WK, Cho N, Yi A, Koo HR, Han W, Noh DY, Moon HG, Kim SJ. Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat. 2011 Aug;129(1):89-97.25-Chang JM, Won JK, Lee KB, Park IA, Yi A, Moon WK. Comparison of shear-wave and strain ultrasound elastography in the differentiation of benign and malignant breast lesions. AJR Am J Roentgenol. 2013 Aug;201(2):W347-56.26-Dobruch-SobczakK, Nowicki A. Role of shear wave sonoelastographyin differentiation between focal breast lesions. Ultrasound Med Biol. 2015;41(2):366–7427-Ko KH, Jung HK, Kim SJ, Kim H, Yoon JH. Potential role of shear-wave ultrasound elastography for the differential diagnosis of breast non-mass lesions: preliminary report. Eur Radiol. 2014 Feb;24(2):305-11.28-YoukJH, GweonHM, Son EJ, Han KH, Kim JA. Diagnostic value of commercially available shear-wave elastography for breast cancers: integration into BI-RADS classification with subcategories of category 4. Eur Radiol. 2013 Oct;23(10):2695-704.29-Yoon JH, Jung HK, Lee JT, Ko KH. Shear-wave elastography in the diagnosis of solid breast masses: what leads to false-negative or false-positive results? Eur Radiol. 2013 Sep;23(9):2432-40.30-Kim MY, Choi N, Yang JH, YooYB, Park KS. False positive or negative results of shear-wave elastography in differentiating benign from malignant breast masses: analysis of clinical and ultrasonographic characteristics. Acta Radiol. 2015 Oct;56(10):1155-62.31-Lee SH, Chang JM, Kim WH, Bae MS, SeoM, Koo HR, Chu AJ, GweonHM, Cho N, Moon WK. Added value of shear-wave elastography for evaluation of breast masses detected with screening US imaging. Radiology. 2014 Oct;273(1):61-9.32-Lee SH, Chang JM, Cho N, Koo HR, Yi A, Kim SJ, YoukJH, Son EJ, Choi SH, Kook SH, Chung J, Cha ES, Park JS, Jung HK, Ko KH, Choi HY, Ryu EB, Moon WK; Korean Breast Elastography Study Group. Practice guideline for the performance of breast ultrasound elastography. Ultrasonography. 2014 Jan;33(1):3-10.33-PlechaDM, Pham RM, Klein N, Coffey A, Sattar A, Marshall H. Addition of shear-wave elastography during second-look MR imagingdirectedbreast US: effect on lesion detection and biopsy targeting. Radiology. 2014 Sep;272(3):657-6434-Mullen R, Thompson JM, Moussa O, VinnicombeS, Evans A. Shear-wave elastography contributes to accurate tumoursize estimation when assessing small breast cancers. Clin Radiol. 2014 Dec;69(12):1259-63.35-Feldmann A, Langlois C, DewaillyM, Martinez EF, Boulanger L, KerdraonO, Faye N. Shear Wave Elastography (SWE): An Analysis of Breast Lesion Characterization in 83 Breast Lesions. Ultrasound Med Biol. 2015 Oct;41(10):2594-604.
Sources36-Au FW, GhaiS, Lu FI, MoshonovH, Crystal P. Quantitative shear wave elastography: correlation with prognostic histologic features and immunohistochemical biomarkers of breast cancer. AcadRadiol. 2015 Mar;22(3):269-77.37-Chang JM, Park IA, Lee SH, Kim WH, Bae MS, Koo HR, Yi A, Kim SJ, Cho N, Moon WK. Stiffness of tumoursmeasured by shear-wave elastography correlated with subtypes of breast cancer. Eur Radiol. 2013 Sep;23(9):2450-8.38-Lee SH, Moon WK, Cho N, Chang JM, Moon HG, Han W, Noh DY, Lee JC, Kim HC, Lee KB, Park IA. Shear-wave elastographicfeatures of breast cancers: comparison with mechanical elasticity and histopathologic characteristics. Invest Radiol. 2014 Mar;49(3):147-55.39-GanauS, Andreu FJ, EscribanoF, Martín A, TortajadaL, VillajosM, BaréM, TeixidóM, RibéJ, SentísM. Shear-wave elastography and immunohistochemical profiles in invasive breast cancer: evaluation of maximum and mean elasticity values. Eur J Radiol. 2015 Apr;84(4):617-2240-Evans A, WhelehanP, Thomson K, McLean D, BrauerK, Purdie C, Baker L, Jordan L, RauchhausP, Thompson A. Invasive breast cancer: relationship between shear-wave elastographicfindings and histologic prognostic factors. Radiology. 2012 Jun;263(3):673-741-Mori M, TsunodaH, Kawauchi N, Kikuchi M, Honda S, Suzuki K, Yamauchi H. Elastographicevaluation of mucinous carcinoma of the breast. Breast Cancer. 2012 Jan;19(1):60-342-BrkljaçiçB, DivjakE, Tomasoviç-LonçariçÇ, TešiçV, IvanacG. Shear-wave sonoelastographicfeatures of invasive lobular breast cancers. Croat Med J. 2016;57:42-5043-Lee EJ, Jung HK, Ko KH, Lee JT, Yoon JH. Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses? Eur Radiol. 2013 Jul;23(7):1803-1144-Evans A, RauchhausP, WhelehanP, Thomson K, Purdie CA, Jordan LB, Michie CO, Thompson A, VinnicombeS. Does shear wave ultrasound independently predict axillary lymph node metastasis in women with invasive breast cancer? Breast Cancer Res Treat. 2014 Jan;143(1):153-745-YoukJH, GweonHM, Son EJ, Kim JA, JeongJ. Shear-wave elastography of invasive breast cancer: correlation between quantitative mean elasticity value and immunohistochemical profile. Breast Cancer Res Treat. 2013 Feb;138(1):119-26.46-DžoiçDominkoviçM, IvanacG, KelavaT, BrkljaçiçB. Elastographicfeatures of triple negative breast cancers. Eur Radiol. 2015 Aug 1. [Epubahead of print]47-Boisserie-Lacroix M, Mac Grogan G, DebledM, Ferron S, Asad-Syed M, BrousteV, Mathoulin-PelissierS, Hurtevent-LabrotG. Radiological features of triple-negative breast cancers (73 cases). Diagn IntervImaging. 2012 Mar;93(3):183-90
Sources48-Evans A, Armstrong S, WhelehanP, Thomson K, RauchhausP, Purdie C, Jordan L, Jones L, Thompson A, VinnicombeS. Can shear-wave elastography predict response to neoadjuvant chemotherapy in women with invasive breast cancer? Br J Cancer. 2013 Nov 26;109(11):2798-802.49-AthanasiouA, Latorre-Ossa H, CritonA, TardivonA, GennissonJL, TanterM. Feasibility of Imaging and Treatment Monitoring of Breast Lesions with Three-Dimensional Shear Wave Elastography. UltraschallMed. 2015 Mar 5. [Epubahead of print]50-Lee SH, Chang JM, Han W, Moon HG, Koo HR, GweonHM, Kim WH, Noh DY, Moon WK. Shear-Wave Elastography for the Detection of Residual Breast Cancer After Neoadjuvant Chemotherapy. Ann Surg Oncol. 2015 Dec;22 Suppl 3:376-84.