Ultrasound elastography evaluation of breast masses with FNAC and/or histopathological correlation


  • Shyam Chhadi Department of Radiology, Government Medical College & Hospital, Nagpur, Maharashtra, India
  • Tulsi Chhadi Department of Pathology, Indira Gandhi Government Medical College & Hospital, Nagpur, Maharashtra, India
  • Kamlesh Bagde Department of Radiology, Government Medical College & Hospital, Nagpur, Maharashtra, India




Breast mass, FNAC, Histopathology, Ultrasound elastography


Background: Breast cancer is the most frequently diagnosed cancer amongst women worldwide. Ultrasound elastography is a non-invasive method for determining tissue mechanical properties and seems to be compensating for the deficiencies of conventional USG. We aimed to evaluate the sensitivity and specificity of ultrasound elastography in detection and characterization of various breast masses and study its role in differentiating benign and malignant breast masses with FNAC and/or histopathological correlation.

Methods: A total of 126 patients with breast lesions confirmed on USG were enrolled for the study, out of which 10 were lost to follow-up and excluded. Consecutive patients presenting with palpable breast lesions were assessed with conventional B-mode USG. Those confirmed to have breast lesion were then assessed with Strain Elastography (SE). FNAC was used for histopathological confirmation of malignant lesions. The benign lesions were diagnosed by a combination of FNAC and biopsy and were followed up for 6 months.

Results: There were 56 (48.3%) malignant and 60 (51.7%) benign lesions. A sensitivity of 83.9% and a specificity of 91.7% was obtained for elasticity score when cut-off value of 3.5 was used (area under the curve- 0.924, 95% CI- 0.869 to 0.979, p-0.0001). Sensitivity of 91.1% and specificity of 88.3% was obtained for SR scores, when a cut off of 2.94 was used (area under the curve- 0.969, 95% CI- 0.943-0.995, p-0.0001). The Pearson correlation coefficient for elasticity scores and SR values was 0.936, indicating very good agreement (correlation) between the two methods.

Conclusions: Ultrasound elastography is a simple and rapid method that can improve the sensitivity and specificity of USG and can decrease the rate of unnecessary biopsies.


Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians. 2018 Sep 12.

Saarenma I, Salminem T, Geiger U, Heikkinen P, Hyvvarinen S, Isola J. The effect of age and density of the breast on the sensitivity of breast cancer diagnostic by mammography and ultrasonography. Breast Cancer Res Treat. 2001;67:11-123.

Olsen O, Gotzsche PC. Cochrane review on screening for breast cancer with mammography. Lancet. 2001;358:1340-2.

Breast Imaging Reporting and Data System (BIRADS). ACR BI-RADS Atlas®. 5th ed. Available at: https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads. Accessed on 04 October 2018.

Duncan JL, Cederbom GJ, Champaign JL, Smetherman DH, King TA, Farr GH. Benign diagnosis by image-guided core-needle breast biopsy. Ak Surg. 2000 Jan;66(1):5-9.

Chiou SY, Chou YH, Chiou HJ, Wang HK, Tiu CM, Tseng LM. Sonographic features of non-palpable breast cancer: a study based on ultrasound-guided wire-localized surgical biopsies. Ultrasound Med Biol. 2006;32:1299-1306.

Rizzatto G. Real-time elastography of the breast in clinical practice: The Italian experience. Medix Hitachi Suppl. 2007;1:12-15.

Itoh A. Review of the techniques and diagnostic criteria of breast ultrasound elastography. Medix Hitachi Suppl. 2007;1:8-11.

Ophir J, Cespedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13:111-34.

Konofagou EE. Quo Vadis elasticity imaging? Ultrasonics. 2004;42:331-6.

Itoh A, Ueno E, Tohno E, Kamma H, Takahashi H, Shiina T, et al. Breast disease: clinical application of US elastography for diagnosis. Radiology. 2006;239:341-50.

Zhi H, Ou B, Luo BM, Feng X, Wen YL, Yang HY. Comparison of ultrasound elastography, mammography and sonography in the diagnosis of solid breast lesions. J Ultrasound Med. 2007;26:807-15.

Barr RG, Destounis S, Lackey LB, Svensson WE< Balleyguier C, Smith C. Evaluation of breast lesions using sonographic elasticity imaging: a multicenter trial. J Ultrasound Med. 2012;31:281-7.

Thomas A, Degenhardt F, Farrokh A. Significant differentiation of focal breast lesions: calculation of strain ratio in breast sonoelastography. Acad Radiol. 2010;17(5):558-63.

Wang Z, Yang T, Wu Z, Tang S, Liang X, Qin A, et al. Correlation between elastography score and strain ratio in breast small tumour. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2010;35:928-32.

Kumm TR, Szabunio MM. Elastography for the characterization of breast lesions: initial clinical experience. Cancer Control. 2010;17(3):156-61.

Tan Sm, The HS, Mancer JF, Poh WT. Improving B-mode ultrasound evaluation of breast lesions with real-time ultrasound elastography: a clinical approach. Breast. 2008;17:252-7.

Zhi H, Xiao XY, Yang HY, Wen YL, Ou B, Luo BM, et al. Semi-quantitative stiffness of breast solid lesions in ultrasound elastography. Acad Radiol. 2008;15:1347-53.

Starvos AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: Use of sonography to distinguish benign and malignant lesions. Radiology. 1995;196:123-34.

Thomas A, Kummel S, Fritsche F, Warm M, Ebert B, Hamm B, et al. Real-time sonoelastography performed in addition to B-mode ultrasound and mammography: Improved differentiation of breast lesions? Acad Radiol. 2006;13:1496-504.

Giuseppetti GM, Martegani A, DI Cioccio B, BAldassarre S. Elastography in the diagnosis of the nodular breast lesions: Preliminary report. Radiol Med. 2005;110:69-76.




How to Cite

Chhadi, S., Chhadi, T., & Bagde, K. (2018). Ultrasound elastography evaluation of breast masses with FNAC and/or histopathological correlation. International Journal of Research in Medical Sciences, 6(12), 4034–4038. https://doi.org/10.18203/2320-6012.ijrms20184903



Original Research Articles