Vol. 6, Issue 2, Part A (2024)

Background: Breast cancer remains a significant global healthcare challenge, with approximately 570,000 breast cancer-related deaths reported in 2015. Historically, the evaluation of breast masses relied heavily on physical palpation by physicians. However, recent advancements have introduced elastography into imaging systems, which assesses the elasticity or softness of breast lesions using ultrasound. This study aims to evaluate the efficacy of shear wave elastography in downgrading solid breast masses, reducing the false positive predictive value of the BI-RADS system, and minimizing unnecessary benign biopsies. 
Method: cross-sectional analytic study involved 51 female patients attending the Breast Clinic at Al-Yarmouk Teaching Hospital in Baghdad for routine check-ups or follow-up of previously diagnosed breast pathology. Each patient underwent breast ultrasound, followed by a true cut biopsy. The breast lumps were classified into BI-RADS III and IV, with tissue elasticity measured by shear wave elastography. These findings were then compared with histopathology results. Results: the study found a strong correlation between breast lump shape and malignancy (P = 0.007), with the majority of malignant tumors (94.1%) exhibiting irregular shapes. Masses with shear wave values exceeding 64 Kpa were predominantly malignant (88.9%, p< 0.001). Malignancy was significantly higher among BI-RADS IV masses (82.1%, p< 0.001). Hypoechoic and heterogeneous patterns were also more common in malignant lumps (p< 0.001). 
Conclusion: shear wave elastography demonstrated high sensitivity and specificity, significantly reducing the false positive rate of malignancy in BI-RADS IV classified breast masses.