Second-Look Ultrasound Using Shear-Wave Elastography in MRI-Suspected Locoregional Recurrence of Breast Carcinoma

Eugen Divjak*, Gordana Ivanac, Niko Radović, Iva Biondić Špoljar, Slavica Sović, Valentina Bahnik, Boris Brkljačić

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose To investigate if second-look US using shear-wave elastography (SWE) can help to differentiate between benign and malignant changes in the postoperative breast after surgical treatment of breast carcinoma. Materials and Methods SWE and related sonographic features were reviewed in 90 female patients with a history of surgical treatment of breast carcinoma and a suspicious lesion detected on a follow-up MRI scan. A single experienced radiologist performed all second-look US exams with SWE measurements placing a circular region of interest measuring 2 mm in diameter over the stiffest part of the lesion. Tissue samples for histopathological analysis were obtained during the same US examination via core-needle biopsy. Results Out of 90 lesions, 39 were proven malignant on histopathological analysis. 50 % of malignant lesions had El maxvalues ranging from 128 to 199 kPa, and 50 % of benign lesions had El maxvalues ranging from 65 to 169 kPa. The cut-off value of 171.2 kPa for El maxshows a sensitivity of 59 % and specificity of 78.4 % for carcinoma recurrence, area under the curve 0.706 (CI95 % 0.6-0.81), P = 0.001. In univariate logistic models, restricted diffusion and stiffness on SWE, El max> 171.2 kPa, were shown as significant recurrence predictors. In the multivariate model, restricted diffusion remains significant independent recurrence predictor. With a recurrence prevalence of 43 %, the test sensitivity is 95 % (CI95 % 81-99 %) and the specificity is 75 % (CI95 % 60-85 %). Conclusion Stiffer lesions should be considered suspicious on second-look US in the postoperative breast and SWE can be a helpful tool in identifying malignant lesions, especially if this is related to restricted diffusion on MRI exam. Lesion stiffness, however, should not be considered as an independent predictor of lesion malignancy in the postoperative breast, because of benign changes that can appear stiff on SWE, as well as carcinoma recurrences that may appear soft.

Original languageEnglish
Pages (from-to)274-279
Number of pages6
JournalUltraschall in der Medizin
Issue number3
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
This work has been supported by Croatian Science Foundation under the project IP-2016-06-2997 “Sonoelastography and MRI in diagnosis and treatment of breast cancer”.

Publisher Copyright:
© 2022 Georg Thieme Verlag. All rights reserved.

Thieme. All rights reserved.

Other keywords

  • breast
  • carcinoma recurrence
  • sonoelastography
  • Neoplasm Recurrence, Local/diagnostic imaging
  • Breast Neoplasms/diagnostic imaging
  • Diagnosis, Differential
  • Reproducibility of Results
  • Breast/diagnostic imaging
  • Humans
  • Ultrasonography, Mammary
  • Magnetic Resonance Imaging
  • Carcinoma/pathology
  • Sensitivity and Specificity
  • Female
  • Elasticity Imaging Techniques


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