Original Article

Efficacy of Sonoelastography in Distinguishing Benign from Malignant Breast Masses


  • Adile Balçık
  • Ahmet Veysel Polat
  • İlkay Koray Bayrak
  • Ayfer Kamalı Polat

Received Date: 17.11.2015 Accepted Date: 21.11.2015 Eur J Breast Health 2016;12(1):37-43


The study aimed to evaluate the influence of sonoelastographic strain ratio in distinguishing benign from malignant breast masses.

Materials and Methods:

Patients who were referred for diagnostic biopsy of a breast mass were examined by ultrasound and sonoelastography prior to percutaneous biopsy. Sonoelastography was performed twice by the same observer in the same session. The strain ratios (SR) were calculated for both measurements as well as the mean strain ratio. Results were compared with histopathologic findings. For each strain ratio, a threshold value was determined using a ROC analysis for the differentiation of benign and malignant masses.


After histopathological examination of 135 mass lesions in 132 female patients (mean age 48±12 years), 65 masses were diagnosed as benign and 70 as malignant. According to the Tsukuba classification with 5 scores; 44 of 65 benign masses had scores of either 1 or 2 while 56 of 70 malignant lesions had scores of either 4 or 5. No benign lesion was classified as score 5, and no malignant lesion as score 1. The mean cut-off in the two ROC measurements in distinguishing benign from malignant lesions was calculated as 4.52. When a threshold value of 4.52 was used for the mean strain ratio: the sensitivity, specificity, PPV, NPV, and accuracy rates were determined as 85.5%, 84.8%, 85.5%, 84.8% and 85.2%, respectively.


The threshold value for strain ratio in the differentiation of benign and malignant masses was detected as 4.52, and a significant intraobserver difference was not observed in this study. The diagnostic value of sonoelastograghy in distinguishing benign from malignant breast masses was higher in comparison to conventional ultrasound.

Keywords: Breast neoplasm, ultrasound, sonoelastography