Elastography of the Breast: Imaging Techniques and Pitfalls in Interpretation

ABSTRACT

Ultrasound (US) elastography is a tool that indicates the hardness of a lesion. Recent studies using elastography with freehand compression have shown similar diagnostic performance to conventional US in differentiating benign lesions from malignant breast masses. On the other hand, the acquired information is not quantitative, and the reliability of the imaging technique to correctly compress the tissue depends on the skill of the operator, resulting in substantial interobserver variability during data acquisition and interpretation. To overcome this, shear wave elastography was developed to provide quantitative information on the tissue elasticity. The system works by remotely inducing mechanical vibrations through the acoustic radiation force created by a focused US beam. This review discusses the principles and examination techniques of the two types of elastography systems and provides practical points to reduce the interobserver variability or errors during data acquisition and interpretation.