Two-View versus Single-View Shear-Wave Elastography: Comparison of Observer Performance in Differentiating Benign from Malignant Breast Masses

Abstract

Purpose: To determine whether two-view shear-wave elastography (SWE) improves the performance of radiologists in differentiating benign from malignant breast masses compared with single-view SWE.Materials and Methods: This prospective study was conducted with institutional review board approval, and written informed consent was obtained. B-mode ultrasonographic (US) and orthogonal SWE images were obtained for 219 breast masses (136 benign and 83 malignant; mean size, 14.8 mm) in 219 consecutive women (mean age, 47.9 years; range, 20-78 years). Five blinded radiologists independently assessed the likelihood of malignancy for three data sets: B-mode US alone, B-mode US and single-view SWE, and B-mode US and two-view SWE. Interobserver agreement regarding Breast Imaging Reporting and Data System (BI-RADS) category and the area under the receiver operating characteristic curve (AUC) of each data set were compared.Results: Interobserver agreement was moderate (k = 0.560 +/- 0.015 [standard error of the mean]) for BI-RADS category assessment with B-mode US alone. When SWE was added to B-mode US, five readers showed substantial interobserver agreement (k = 0.629 +/- 0.017 for single-view SWE; k = 0.651 +/- 0.014 for two-view SWE). The mean AUC of B-mode US was 0.870 (range, 0.855-0.884). The AUC of B-mode US and two-view SWE (average, 0.928; range, 0.904-0.941) was higher than that of B-mode US and single-view SWE (average, 0.900; range, 0.890-0.920), with statistically significant differences for three readers (P <= .003).Conclusion: The performance of radiologists in differentiating benign from malignant breast masses was improved when B-mode US was combined with two-view SWE compared with that when B-mode US was combined with single-view SWE.