Skip to main content

Advertisement

Log in

The diagnostic value of ultrasound and shear wave elastography in the differentiation of benign and malignant soft tissue tumors

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Aim

To evaluate the diagnostic value of ultrasound (US) and shear wave elastography (SWE) in the differentiation of benign and malignant soft tissue tumors.

Materials and methods

A hundred and nine patients (mean age 43.3 ± 20.5, range 0–85; 64 men and 45 women) diagnosed with soft tissue tumors between August 2016 and January 2020 were evaluated with US and SWE. The stiffness of the lesions was measured as mean and maximum shear wave velocity (SWVmean and SWVmax) in meters/second (m/s). Two radiologists evaluated the US images independently and then reached a final consensus. Final diagnosis was obtained either by histopathological examination (core needle biopsy or surgery) or by follow-up. The diagnostic value of US and SWE in the differentiation of malignant and benign lesions was assessed.

Results

Pathology results revealed 37 malignant and 43 benign lesions. Twenty-nine lesions were benign based on follow-up criteria. Consensus US reading revealed 91.9% sensitivity and 72.2% specificity with almost perfect inter-observer agreement (κ = 0.802). Larger lesion size, male gender, advanced patient age, deep location, hypoechoic and hypervascular appearance, ill-defined margins, and presence of cystic area were associated with malignant diagnosis (p < 0.001, p = 0.010, p = 0.001, p = 0.001, p = 0.003, p < 0.001, p = 0.001, and p = 0.011, respectively). Median SWVmean and median SWVmax of malignant lesions (2.87 and 2.68) were not significantly different than those of the benign lesions (3.30 and 3.05; p = 0.271 and p = 0.402, respectively).

Conclusion

US features can differentiate malignant and benign soft tissue tumors, whereas SWE did not contribute to the differentiation of soft tissue tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Wagner JM, Lamprich BK. Ultrasonography of lumps and bumps. Ultrasound Clin. 2014;9(3):373–90.

    Article  Google Scholar 

  2. Fletcher C, Rydolm A, Singer S, et al. Soft tissue tumors: epidemiology, clinical features, histopathological typing and grading. In: Fletcher C, Unni K, Mertens F, editors. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Soft Tissue and Bone. Lyon (France): International Agency for Research on Cancer; 2002. p. 12–8.

    Google Scholar 

  3. Lakkaraju A, Sinha R, Garikipati R, Edward S, Robinson P. Ultrasound for initial evaluation and triage of clinically suspicious soft-tissue masses. Clin Radiol. 2009;64(6):615–21.

    Article  CAS  PubMed  Google Scholar 

  4. Kransdorf MJ, Murphey MD. Imaging of soft tissue tumors. Philedelphia: Lippincott Williams & Wilkins; 2006.

    Google Scholar 

  5. Wagner JM, Lee KS, Rosas H, Kliewer MA. Accuracy of sonographic diagnosis of superficial masses. J Ultrasound Med. 2013;32(8):1443–50.

    Article  PubMed  Google Scholar 

  6. DiDomenico P, Middleton W. Sonographic evaluation of palpable superficial masses. Radiol Clin N Am. 2014;52:1295–305.

    Article  PubMed  Google Scholar 

  7. Polat AV, Ozturk M, Akyuz B, Celenk C, Kefeli M, Polat C. The diagnostic value of shear wave elastography for parathyroid lesions and comparison with cervical lymph nodes. Med Ultrason. 2017;19:386–91.

    Article  PubMed  Google Scholar 

  8. Gürüf A, Öztürk M, Bayrak İK, Polat AV. Shear wave versus strain elastography in the differentiation of benign and malignant breast lesions. Turkish J Med Sci. 2019;49(5):1509–17.

    Article  Google Scholar 

  9. Turgut E, Celenk C, Tanrivermis Sayit A, Bekci T, Gunbey HP, Aslan K. Efficiency of B-mode ultrasound and strain elastography in differentiating between benign and malignant cervical lymph nodes. Ultrasound Q. 2017;33(3):201–7.

    Article  PubMed  Google Scholar 

  10. Bekci T, Bilgici MC, Genc G, Tekcan D, Polat AV, Tomak L. Evaluation of renal parenchyma elasticity with acoustic radiation force impulse quantification in nutcracker syndrome and comparisons with grayscale Doppler sonography and laboratory findings. J Ultrasound Med. 2017;36(1):61–7.

    Article  PubMed  Google Scholar 

  11. Krouskop TA, Wheeler TM, Kallel F, Garra BS, Hall T. Elastic moduli of breast and prostate tissues under compression. Ultrason Imaging. 1998;20(4):260–74.

    Article  CAS  PubMed  Google Scholar 

  12. Nazarian LN. Science to practice: can sonoelastography enable reliable differentiation between benign and metastatic cervical lymph nodes? Radiology. 2007;243:1–2.

    Article  PubMed  Google Scholar 

  13. Garra BS, Cespedes EI, Ophir J, et al. Elastography of breast lesions: initial clinical results. Radiology. 1997;202(1):79–86.

    Article  CAS  PubMed  Google Scholar 

  14. Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237(1):202–11.

    Article  PubMed  Google Scholar 

  15. Pass B, Jafari M, Rowbotham E, Hensor EMA, Gupta H, Robinson P. Do quantitative and qualitative shear wave elastography have a role in evaluating musculoskeletal soft tissue masses? Eur Radiol. 2017;27(2):723–31.

    Article  CAS  PubMed  Google Scholar 

  16. Magarelli N, Carducci C, Bucalo C, et al. Sonoelastography for qualitative and quantitative evaluation of superficial soft tissue lesions: a feasibility study. Eur Radiol. 2014;24(3):566–73.

    Article  PubMed  Google Scholar 

  17. Park HJ, Lee SY, Lee SM, Kim WT, Lee S, Ahn KS. Strain elastography features of epidermoid tumours in superficial soft tissue: differences from other benign soft-tissue tumours and malignant tumours. Br J Radiol. 2015;88:20140797.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hahn S, Lee YH, Lee SH, Suh J-S. Value of the strain ratio on ultrasonic elastography for differentiation of benign and malignant soft tissue tumors. J Ultrasound Med. 2017;36(1):121–7.

    Article  PubMed  Google Scholar 

  19. Riishede I, Ewertsen C, Carlsen J, Petersen MM, Jensen F, Nielsen MB. Strain elastography for prediction of malignancy in soft tissue tumours - preliminary results. Ultraschall Med. 2015;36(4):369–74.

    Article  CAS  PubMed  Google Scholar 

  20. Pass B, Johnson M, Hensor EMA, Gupta H, Robinson P. Sonoelastography of musculoskeletal soft tissue masses: a pilot study of quantitative evaluation. J Ultrasound Med. 2016;35(10):2209–16.

    Article  PubMed  Google Scholar 

  21. Tavare AN, Alfuraih AM, Hensor EMA, Astrinakis E, Gupta H, Robinson P. Shear-wave elastography of benign versus malignant musculoskeletal soft-tissue masses: comparison with conventional US and MRI. Radiology. 2019;290(2):410–7.

    Article  PubMed  Google Scholar 

  22. Winn N, Baldwin J, Cassar-Pullicino V, et al. Characterization of soft tissue tumours with ultrasound, shear wave elastography and MRI. Skeletal Radiol. 2020;49:869–81.

    Article  CAS  PubMed  Google Scholar 

  23. Yeoh HJ, Kim T-Y, Ryu JA. The feasibility of shear wave elastography for diagnosing superficial benign soft tissue masses. Ultrasonography. 2019;38(1):37–43.

    Article  PubMed  Google Scholar 

  24. Li A, Peng XJ, Ma Q, Dong Y, Mao CL, Hu Y. Diagnostic performance of conventional ultrasound and quantitative and qualitative real-time shear wave elastography in musculoskeletal soft tissue tumors. J Orthop Surg Res. 2020;15(1):103.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Morii T, Kishino T, Shimamori N, et al. Differential diagnosis between benign and malignant soft tissue tumors utilizing ultrasound parameters. J Med Ultrason. 2018;45(1):113–9.

    Article  Google Scholar 

  26. Klauser AS, Tagliafico A, Allen GM, et al. Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European society of musculoskeletal radiology. Eur Radiol. 2012;22:1140–8.

    Article  PubMed  Google Scholar 

  27. McNally EG. The development and clinical applications of musculoskeletal ultrasound. Skelet Radiol. 2011;40:1223–31.

    Article  Google Scholar 

  28. Kransdorf MJ, Murphey MD, Wessell DE, et al. ACR Appropriateness Criteria ® soft-tissue masses. J Am Coll Radiol. 2018;15(5):189–97.

    Article  Google Scholar 

  29. Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Radiology. 2015;277:826–32.

    Article  PubMed  Google Scholar 

  30. Giovagnorio F, Andreoli C, De Cicco ML. Color Doppler sonography of focal lesions of the skin and subcutaneous tissue. J Ultrasound Med. 1999;18(2):89–93.

    Article  CAS  PubMed  Google Scholar 

  31. Hung EHY, Griffith JF, Yip SWY, Ivory M, Lee JCH, Ng AWH, et al. Accuracy of ultrasound in the characterization of superficial soft tissue tumors: a prospective study. Skelet Radiol. 2020;49:883–92.

    Article  Google Scholar 

  32. Hung GY, Horng JL, Chen PC, et al. Incidence of soft tissue sarcoma in Taiwan: a nationwide population-based study (2007-2013). Cancer Epidemiol. 2019;60:185–92.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mesut Ozturk.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

IRB approval

The study was approved by the institutional review board.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ozturk, M., Selcuk, M.B., Polat, A.V. et al. The diagnostic value of ultrasound and shear wave elastography in the differentiation of benign and malignant soft tissue tumors. Skeletal Radiol 49, 1795–1805 (2020). https://doi.org/10.1007/s00256-020-03492-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03492-y

Keywords

Navigation