Breast Cancer Research and Treatment

, Volume 174, Issue 2, pp 423–432 | Cite as

Combination of different types of elastography in downgrading ultrasound Breast Imaging-Reporting and Data System category 4a breast lesions

  • Xueyi Zheng
  • Yini Huang
  • Yun Wang
  • Yubo Liu
  • Fei Li
  • Jing Han
  • Jianwei Wang
  • Longhui Cao
  • Jianhua ZhouEmail author
Clinical trial



To determine whether a combination of different types of elastography could improve the accuracy of elastography-aided downgrading ultrasound (US) Breast Imaging-Reporting and Data System (BI-RADS) category 4a lesions.

Materials and methods

From January 2016 to May 2018, 458 consecutive women with 494 US BI-RADS category 4a breast lesions were enrolled in the prospective study. These lesions were subject to conventional US supplemented with strain elastography of elasticity imaging (EI), virtual touch tissue imaging (VTI), and shear wave elastography of virtual touch imaging quantification (VTIQ). Diagnostic performances were calculated for BI-RADS, EI, VTI, and VTIQ as well as the combination of EI, VTI, and VTIQ (combination of EI and VTI [EI + VTI], combination of EI and VTIQ [EI + VTIQ], and combination of VTI and VTIQ [VTI + VTIQ]).


Pathologically, 445 lesions (90.1%) were benign, and 49 (9.9%) were malignant. The specificities of EI, VTI, and VTIQ were significantly higher than those of BI-RADS (69.9%, 83.8%, 75.5% vs. 0, respectively, P < 0.001), while their sensitivities were significantly lower than those of BI-RADS (83.7%, 73.5%, 65.3% vs. 100%, respectively, P < 0.05). Among the combinations, EI + VTI and EI + VTIQ showed similar sensitivity to BI-RADS (98% vs 100%, P = 1.000; 93.9% vs 100%, P = 0.25), while the specificity of EI + VTI was significantly higher than that of EI + VTIQ and BI-RADS (P < 0.001). When using EI + VTI to downgrade lesions, 58.7% of these lesions were downgraded, among those 99.7% were benign.


Combinations of EI and VTI to downgrade BI-RADS category 4a lesions may reduce the misdiagnosis of breast cancers and the number of unnecessary biopsies.


Breast Neoplasms Ultrasonography Elasticity imaging techniques Sensitivity Specificity 





Breast Imaging-Reporting and Data System


Elastic imaging


Virtual touch tissue imaging


Virtual touch imaging quantification


Shear wave velocity


Area under the receiver operating characteristic curve


Combination of EI and VTI


Combination of EI and VTIQ


Combination of VTI and VTIQ


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The experiments comply with the current laws of China.

Informed consent

Verbal informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ultrasound, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat-Sen University Cancer CenterGuangzhouPeople’s Republic of China
  2. 2.Department of Anesthesiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat-Sen University Cancer CenterGuangzhouPeople’s Republic of China

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