Main Article Content


Objective: To evaluate and compare the diagnostic performance of strain elastography (SE), B-mode ultrasound (B-mode US), and the combination of the two modalities in the characterization of benign and malignant breast lesions.

Materials and methods: The prospective study included 375 breast masses, between January 2017 and January 2020. B mode ultrasound and elastography were established for each mass. The area under the curve (AUC), sensitivity, specificity, and positive predictive value (PPV) were calculated for comparison between elastography, B mode ultrasound, and the combination of the two exams. The pathological findings were used as the reference standard.

Results: Among 375 breast masses, 77 of the lesions were malignant, 298 were benign. The association of elastography with B mode ultrasound increased the AUC from 0.62 to 0.86 (95% CI: 0.78, 0.93; P < 0.0001); specificity from 23.6% (95% CI: 23%, 35.6%) to 98.03% (95% CI: 96.1%, 100%; P < 0.0001) with a decrease in sensitivity from 100% to 72.92% (CI 95%: 66.8%, 79.1%; P < 0.001); and PPV from 29.27% (CI 95%: 23%, 35.6%) to 92.11% (CI 95%: 88.4%, 95.8%; P < 0.0001).

Conclusion: The combination of elastography and B mode ultrasound increases diagnostic performance in the characterization of benign and malignant breast lesions.


Objectif : Évaluer et comparer les performances diagnostiques de l’élastographie statique (ES) et de l’échographie mode B (US mode B) et de la combinaison des deux modalités dans la caractérisation des lésions mammaires bénignes et malignes.

Matériels et méthodes : Étude prospective, incluant 375 masses mammaires, entre janvier 2017 et janvier 2020. L’échographie mode B et l’élastographie ont été établées pour chaque masse. L’aire sous la courbe, la sensibilité, la spécificité et la valeur prédictive positive (VPP) ont été calculées pour la comparaison entre l’échographie mode B et la combinaison des deux examens. L’analyse histologique a été considérée comme l’examen de référence. 

Résultats : Parmi les 375 masses mammaires, on notait 77 masses malignes et 298 masses bénignes. L’association de l’élastographie à l’échographie mode B augmente l’aire sous la courbe de 0,62 à 0.86 (IC 95% : 0.78, 0.93 ; P < 0.0001) ; spécificité de 23.6% (IC 95% : 23%, 35.6%) à 98.03% (IC 95% : 96.1%, 100% ; P < 0.0001) avec une baisse de sensibilité de 100% à 72.92% (IC 95% : 66.8%, 79.1% ; P < 0.001) ; et VPP de 29.27% (IC 95% : 23%, 35.6%) à 92.11% (IC 95% : 88.4%, 95.8% ; P < 0.0001).

Conclusion : La combinaison de l’élastographie et de l’échographie mode B augmente les performances diagnostiques dans la caractérisation des lésions mammaires bénignes et malignes.

Article Details

How to Cite
Administrateur- JAIM, AOUDIA Lynda, KOUCHKAR Amal, & BENDIB Salah Eddine. (2022). Performances de l’élastographie et de l’échographie mode B dans la caractérisation des masses mammaires . Journal Africain d’Imagerie Médicale (J Afr Imag Méd)., 14(1).


  1. 1. Heywang-Kobrunner SH, Schreer I, Bassler R, Perlet C, Viehweg P. Mammographie. Imagerie diagnostique du sein : Mammographie, échographie, IRM, techniques interventionnelles 2007 ; 19-97.
  2. 2. Hellquist BN, Duffy SW, Abdsaleh S, Bjorneld L, Bordas P, Tabar L, et al. Effectiveness of population-based service screening with mammography for women ages 40 to 49 years evaluation of the Swedish Mammography in Young Women (SCRY) cohort. Cancer. 2011; 117 (4): 714-22. doi: 10.1002/cncr.25650
  3. 3. Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Effect of age, breast density, and Family history on the sensitivity of first screening mammography. JAMA. 1996; 276 (1) : 33-8. doi: 10.1001/jama.276.18.1470b.
  4. 4. Mandelson M, Oestreicher N, Porter PL, White D, Finder CA, Taplin SH, et al. Breast density as a predictor of mammographic detection: comparaison of interval and screen detected cancers. J Natl Cancer Inst. 2000; 92 (13): 1081-7. doi: 10.1093/jnci/92.13.1081
  5. 5. Leconte I, Feger C, Galant C, Berlére M, Berg BV, D’Hoore W, et al. Mammography and subsequent whole breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. AJR AmJ Roentgenol. 2003; 180 (6): 1675-9. doi: 10.2214/ajr.180.6.1801675.
  6. 6. D’Orsi CJ et al. ACR BI-RADS ® Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology; 2013.
  7. 7. Chee YL, Crawford JC, Watson HG, Greaves M (2008). Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Journal of Haematology, 140(5), 496-504. doi: 10.1111/j.1365-2141.2007.06968.x.
  8. 8. Kim EK, Ko KH, Oh KK, Kwak JY, You JK, Kim MJ, Park BW. Clinical appliquation of the BI-RADS final assessment to breast sonography in conjunction with mammography. AJR AmJ Roentgenol. 2008; 190 (5) : 1209-15. doi:10.2214/AJR.07.3259.
  9. 9. Hamy AS, Giacchetti S, Albiter M, de Bazelaire C, Cuvier C, Perret F et al BI-RADS categorisation of 2,708 consecutive nonpalpable breast lesions in patients referred to a dedicated breast care unit. Eur Radiol. 2012; 22 (1): 9-17. doi: 10.1007/s00330-011-2201-8.
  10. 10. Lamb PM, Perry NM, Vinnicombe SJ, Wells CA. Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. Clin Radiol. 2000; 55 (1): 40-4. doi: 10.1053/crad.1999.0333.
  11. 11. 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;239:341-350.
  12. 12. Youden WJ. Index for rating diagnostic tests. Cancer. 1950 Jan;3(1):32-5. https://doi: 10.1002/1097-0142(1950)3:1<32: aid-cncr2820030106>;2-3
  13. 13. Stoian D, Timar B, Craina M, Bernad E, PetreI, Craciunescu M. Qualitative strain elastography – strain ratio evaluation – an important tool in breast cancer diagnostic. Med Ultrason 2016, Vol. 18, no. 2, 195-200.
  14. 14. Khamis M, Alaa El-deen AM, Abdel Azim Ismail A. The diagnostic value of sonoelastographic strain ratio in discriminating malignant from benign solid breast masses. The Egyptian Journal of Radiology and Nuclear Medicine 48 (2017) 1149–1157.
  15. 15. Zhao QL, Ruan LT, Zhang H, Yin YM, Duan SX. Diagnosis of solid breast lesions by elastography 5-point score and strain ratio method. European Journal of Radiology 2012;81(11):3245– 9. doi: 10.1016/j.ejrad.2012.06.004
  16. 16. Menezes R, Sardessai S, Furtado R, Sardessai M. Correlation of Strain Elastography with Conventional Sonography and FNAC/Biopsy. Journal of Clinical and Diagnostic Research. 2016 Jul, Vol-10(7): TC05-TC10. doi: 10.7860/JCDR/2016/20239.8177
  17. 17. Redling K, Schwab F, Siebert M, Schötzau A, Zanetti-Dällenbach R. Elastography Complements Ultrasound as Principle Modality in Breast Lesion Assessment. Gynecol Obstet Invest 2016. doi: 10.1159/000445746.
  18. 18. Balçik A, Polat AV, Bayrak İK, Polat AK. Efficacy of sonoelastography in distinguishing benign from malignant breast masses. J Breast Health 2016;12:37–43. doi: 10.5152/tjbh.2015.2843
  19. 19. Dawooda MAA, Ibrahima N, Elsaeeda H, Hegazyb N. Diagnostic performance of sonoelastographic Tsukuba score and strain ratio in evaluation of breast masses. The Egyptian Journal of Radiology and Nuclear Medicine 49 (2018) 265–271.
  20. 20. Seo M, Ahn HS, Park SH, Lee JB, Choi BI, Sohn YM, Shin SY. Comparison and Combination of Strain and Shear Wave Elastography of Breast Masses for Differentiation of Benign and Malignant Lesions by Quantitative Assessment. J Ultrasound Med 2017; 00:00–00 | 0278-4297. doi: 10.1002/jum.14309.
  21. 21. Zhao BX, Yao YJ, Zhou YC, Hao SY, Mu WJ. Strain Elastography: A Valuable Additional Method to BI-RADS?. Published online: September 3, 2018 | Ultraschall in Med.
  22. 22. Gheonea IA, Stoica Z, Bondari S. Differential diagnosis of breast lesions using ultrasound elastography. Indian J Radiol Imaging 2011;21(4):301–5. doi: 10.4103/0971-3026.90697.
  23. 23. Mu WJ, Zhong WJ, Yao JY, Li LJ, Peng YL, Wang Y et al. Ultrasonic elastography research based on a multicenter study: adding strain ratio after 5-point scoring evaluation or not. PLoS ONE 2016;11(2): e0148330. Feb 10.
  24. 24. Chung EM, Cube R, Hall GJ, Gonzalez C, Stocker JT, Glassman LM. From the archives of the AFIP: breast masses in children and adolescents: radiologic-pathologic correlation. RadioGraphics, 2009, 29: 907-931. doi: 10.1148/rg.293095010.
  25. 25. Chao TC, Chao HH, Chen MF. Sonographic features of breast hamartomas. J Ultrasound Med, 2007, 26 : 447-452. doi: 10.7863/jum.2007.26.4.447.
  26. 26. Leong LC, Sim LS, Lee YS, Ng FC, Wan CM, Fook-Chong SM, et al. A prospective study to compare the diagnostic performance of breast elastography versus conventional breast ultrasound. Clin Radiol. 2010 Nov;65(11):887-94.doi :10.1016/j.crad.2010.06.008.
  27. 27. Barr RG. Real-time ultrasound elasticity of the breast: initial clinical results. Ultrasound Quarterly 2010; 26(2):61–6. doi: 10.1097/RUQ.0b013e3181dc7ce4.
  28. 28. Mutala TM, Ndaiga P, Aywak A. Comparison of qualitative and semiquantitative strain elastography in breast lesions for diagnostic accuracy. Cancer Imaging 2016;16(2):1–7. doi : 10.1186/s40644-016-0070-8.
  29. 29. Jung NY, Park CS, Kim SH, Jung HS, Kim K, Lee JW et al. Sonoelastographic strain ratio: how does the position of reference fat influence it? Jpn J Radiol 2016;34 (6):440–7. doi: 10.1007/s11604-016-0543-5.
  30. 30. Arslan S, Uslu N, Ozturk FU, Akcay EY, Tezcaner T, Agildere AM. Can strain elastography combined with ultrasound breast imaging reporting and data system be a more effective method in the differentiation of benign and malignant breast lesions?. J Med Ultrasonics 2017. doi: 10.1007/s10396-017-0772-y.
  31. 31. Bojanic K, Katavic N, Smolic M, Peric M, Kralik K, Sikora M et al. Implementation of elastography score and strain ratio in combination with B-mode ultrasound avoids unnecessary biopsies of breast lesions. Ultrasound in Med. & Biol., Vol. 43, No. 4, pp. 804–816, 2017. doi: 10.1016/j.ultrasmedbio.2016.11.019
  32. 32. Cho N, Moon WK, Park JS, Cha JH, Jang M, Seong MH (2008) Nonpalpable breast masses: evaluation by US elastography. Korean J Radiol 9:111–118. doi: 10.3348/kjr.2008.9.2.111.
  33. 33. Lee SH, Chung J, Choi HY, Choi SH, Ryu EB, Ko KH et al. Evaluation of Screening US-detected Breast Masses by Combined Use of Elastography and Color Doppler US with B-Mode US in Women with Dense Breasts: A Multicenter Prospective Study. Radiology. 2017 Nov;285(2):660-669. doi: 10.1148/radiol.201716242

Most read articles by the same author(s)

1 2 3 4 > >>