Regular breast cancer screening using mammography reduces cancer-related mortality, but results in a large number of potentially avoidable breast biopsy procedures. Magnetic resonance imaging or B-mode breast sonography are highly sensitive for cancer detection (ie, they identify nearly all breast tumors), but at the cost of relatively low specificity (ie, lesions can be at various stages of development and hard to discretely categorize). Breast elastography is a newer technique that utilizes ultrasound to characterize the stiffness or compressibility of breast lesions. Malignant lesions typically exhibit less compression than benign lesions when exposed to the same external force, and measuring tissue deformation in response to an applied stress is a highly sensitive and specific technique for the detection of breast cancers. Three elastographic techniques are currently available (strain elastography, shear-wave elastography, and acoustic radiation force impulse [ARFI] imaging), each of which provides different information about underlying tissue stiffness. Elastography is especially useful for characterizing breast lesions with ambiguous findings on other imaging modalities (ie, with Breast Imaging-Reporting and Data System [BI-RADS] scores of 3 or 4). Clinical studies have demonstrated that the addition of breast elastography to B-mode sonography improves the specificity of breast cancer assessment without sacrificing sensitivity.
After reading this article, the participant should be able to:
- EXPLAIN the basic physiological principles of elastography and summarize three commonly used elastography techniques.
- LIST clinical applications for which breast elastography is most useful.
- RESTATE the accuracy of elastography for the identification of malignant breast lesions.
- IDENTIFY imaging artifacts and other limitations associated with breast elastography.