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What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography?

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Shear wave elastography (SWE) is a promising adjunct to greyscale ultrasound in differentiating benign from malignant breast masses. The purpose of this study was to characterise breast cancers which are not stiff on quantitative SWE, to elucidate potential sources of error in clinical application of SWE to evaluation of breast masses.


Three hundred and two consecutive patients examined by SWE who underwent immediate surgery for breast cancer were included. Characteristics of 280 lesions with suspicious SWE values (mean stiffness >50 kPa) were compared with 22 lesions with benign SWE values (<50 kPa). Statistical significance of the differences was assessed using non-parametric goodness-of-fit tests.


Pure ductal carcinoma in situ (DCIS) masses were more often soft on SWE than masses representing invasive breast cancer. Invasive cancers that were soft were more frequently: histological grade 1, tubular subtype, ≤10 mm invasive size and detected at screening mammography. No significant differences were found with respect to the presence of invasive lobular cancer, vascular invasion, hormone and HER-2 receptor status. Lymph node positivity was less common in soft cancers.


Malignant breast masses classified as benign by quantitative SWE tend to have better prognostic features than those correctly classified as malignant.

Key points:

• Over 90 % of cancers assessable with ultrasound have a mean stiffness >50 kPa.

• ‘Softinvasive cancers are frequently small (≤10 mm), low grade and screen-detected.

• Pure DCIS masses are more often soft than invasive cancers (>40 %).

• Large symptomatic masses are better evaluated with SWE than small clinically occult lesions.

• When assessing small lesions, ‘softnessshould not raise the threshold for biopsy.

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The scientific guarantor of this publication is Professor Andrew Evans. The authors of this manuscript declare relationships with the company Supersonic Imagine. The authors state that this work has not received any funding. One of the authors has significant statistical expertise (Dr Steven Hubbard). Institutional Review Board approval was not required because the technique being evaluated is routine standard of care in our institution. Written informed consent was waived by the Institutional Review Board. However, written informed consent for the use of images was obtained. Some study subjects or cohorts have been previously reported in references 3 and 5 in the manuscript.

Methodology was a retrospective (data collected prospectively, analysed retrospectively), diagnostic or prognostic study, and performed at one institution.

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Correspondence to S. J. Vinnicombe.

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Vinnicombe, S.J., Whelehan, P., Thomson, K. et al. What are the characteristics of breast cancers misclassified as benign by quantitative ultrasound shear wave elastography?. Eur Radiol 24, 921–926 (2014).

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