Histopathology and elastography discordance in evaluation of breast lesions with acoustic radiation force impulse elastography

Purpose
It is known that, besides its benefits, ultrasound (US) elastography may show discordance findings, leading to biopsy, so this technique has some limitations. The purpose of the present study was to compare histopathological results and shear wave velocity (SWV) values in patients, to reveal discordance findings, and to investigate its statistical significance in making the decision for biopsy with SWV values.

Material and methods
A total of 190 patients presenting with breast lesions were included in the study. The mean age of the patients was 39.87 ± 13.56 years. All morphological features of lesions were evaluated by B-mode US. The mean SWV values were measured using the region of interest (ROI) through all lesions with ARFI elastography. An ultrasound-guided Tru-Cut needle biopsy was performed, and histopathologic data were obtained.

Results
The SWV values of false positive benign lesions, such as: granulomatous mastitis, sclerosing adenosis, chronic inflammation, fat necrosis, fibrotic breast tissue, and scar tissue, were as high as the SWV values of malignant lesions. Sensitivity was found as 91.6% and specificity as 40.9% for SWV values in ARFI US.

Conclusions
Our results showed that breast lesions showed false positivity (59.1%) and false negativity (8.3%) in ARFI US. Elastography is useful and sensitive in the evaluation of breast lesions, but some benign lesions may mimic malignant lesions; thus, this information should not be underestimated in biopsy decision-making for elastography users.