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. 2024 Jul 26;16(7):e65449.
doi: 10.7759/cureus.65449. eCollection 2024 Jul.

Advancing Breast Cancer Diagnosis: The Impact of Elastography Integration Into Breast Imaging Reporting and Data System (BIRADS) Categorization

George Asafu Adjaye Frimpong  1   2 , Evans Aboagye  3 , Emmanuel Asante  3 , Osei Owusu-Afriyie  4 , Ernest O Bonsu  5 , Fairuuj Mahama  2
Affiliations

Advancing Breast Cancer Diagnosis: The Impact of Elastography Integration Into Breast Imaging Reporting and Data System (BIRADS) Categorization

George Asafu Adjaye Frimpong et al. Cureus. .

Abstract

Objective: This study evaluates the impact of integrating elastography into the Breast Imaging Reporting and Data System (BIRADS) categorization on breast cancer diagnostics in an African population. It explores the association and agreement between traditional BIRADS and those modified by elastography, as well as between quantitative and qualitative elastography methods.

Methods: A total of 200 participants who underwent breast imaging as part of their diagnostic evaluation for breast lesions were included in the study. Participant characteristics, including age distribution and indicators for breast cancer diagnoses, were analyzed. Brightness mode (B-mode) findings without elastography were assessed using the BIRADS classification. Elastography was integrated into the BIRADS categorization to evaluate its impact on breast cancer diagnostics. The association and agreement between BIRADS with and without elastography were analyzed.

Results: Participants predominantly aged 40-49 showed significant staging differences with the integration of elastography. Traditional B-mode staging identified 29 (49%) of participants in BIRADS stage IV and 14 (23%) in stage V, whereas elastography adjusted these figures significantly, enhancing diagnostic refinement. There was a fair agreement between BIRADS with and without elastography (kappa = 0.322), while a substantial agreement was found between quantitative and qualitative elastography (kappa = 0.674).

Conclusion: The results of the study provide evidence that the integration of elastography into BIRADS categorization can significantly improve the accuracy of breast cancer diagnosis in African women. Elastography enhanced lesion characterization, supporting more personalized and precise clinical management. Continued research is needed to fully integrate elastography into routine diagnostic workflows and understand its broader clinical implications in Africa.

Keywords: breast cancer; diagnostic accuracy; elastography; stiffness; treatment planning.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Committee on Human Research and Ethics, Kwame Nkrumah University of Science and Technology issued approval CHRPE/AP/214/24. Given the retrospective nature of the study, patient consent for inclusion was waived under the condition that all data would be anonymized and handled according to ethical guidelines for research. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Benign lesion: (A) Qualitative elastography shows low stiffness with a predominantly blue color map. (B) Quantitative elastography shows low stiffness with an acoustic radiation force impulse (ARFI) velocity of 0.95 m/s.
Figure 2
Figure 2. Suspicious lesion: (A) Qualitative elastography shows moderate stiffness with an area of red on the color map. (B) Quantitative elastography shows moderate stiffness with an acoustic radiation force impulse (ARFI) velocity of 3.34 m/s.
Figure 3
Figure 3. Malignant lesion: (A) Qualitative elastography shows very high stiffness with a predominantly red color map. (B) Quantitative elastography shows very high stiffness with acoustic radiation force impulse (ARFI) velocity beyond the measurable range recorded as X.XX m/s (≥ 6 m/s).
X.XX m/s denotes SWE exceeding the default upper limit of ultrasound scanner (≥6 m/s).
Figure 4
Figure 4. (A) Age distribution among the study participants and (B) indicators of breast cancer diagnosis.
Figure 5
Figure 5. B-mode findings.
Figure 6
Figure 6. Association between quantitative and qualitative elastography
A p-value less than 0.05 was considered statistically significant.
Figure 7
Figure 7. Association and agreement between BIRADS without elastography and BIRADS with elastography diagnostic methods.
A p-value less than 0.05 was considered statistically significant. BIRADS: Breast Imaging Reporting and Data System
Figure 8
Figure 8. Impact of elastography on ultrasound BIRADS categorization for the histologically confirmed cancers
BIRADS: Breast Imaging Reporting and Data System
Figure 9
Figure 9. Histology confirmed carcinoma (invasive carcinoma): (A) Qualitative elastography shows low stiffness with a predominantly green color map. (B) Quantitative elastography shows low stiffness with an acoustic radiation force impulse (ARFI) velocity of 0.66 m/s.
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