数字钼靶计算机辅助诊断系统检测微钙化团簇的诊断能力评价

目的:自主开发的计算机辅助诊断系统-MCAD,检测数字化乳腺片上的微钙化团簇,提高早期乳腺癌的诊断准确率.方法:从互联网上的权威性数字化乳腺影像数据库下载69个病例,用于有效性研究;对国内29例含微钙化团簇的乳腺癌x线片进行回顾性研究;对国内826例乳腺筛查x线片进行前瞻性研究.将MCAD系统对所有数字化乳腺片上的微钙化团簇检测结果与放射科医师诊断结果比较.结果:在有效性研究中,MCAD系统诊断微钙化团簇的敏感性显著高于两位放射科医师(0.925 vs 0.716,0.75,P＜0.01),特异性则低于放射科医师(0.719 vs 0.938,0.938,P＜0.001),平均每幅图像上有假团簇0.6个.在回顾性研究中,MCAD系统的诊断敏感性高于放射科医师(0.914 vs 0.716,0.8,P=0.098),假阳性团簇的检出数显著高于放射科医师(0.93 vs 0.03,0.07,P＜0.001).在前瞻性研究中,使用MCAD系统亦获得了更高的诊断准确率.结论:MCAD系统对微钙化团簇的检测具有高敏感度,可帮助放射科医师发现隐匿于乳腺片复杂背景中的微钙化团簇,对乳腺癌的早期诊断具有重要意义.     

超声BI-RADS分类结合CEUS诊断乳腺可疑恶性肿块的价值

目的探讨超声BI-RADS分类结合CEUS诊断乳腺可疑恶性肿块的价值。方法术前对超声BI-RADS分类4类以上的66例患者(共计67个病灶)进行CEUS检查,术后均取得病理结果,比较超声BI-RADS分类、单纯CEUS、以及BI-RADS分类联合CEUS对乳腺可疑恶性肿块诊断价值。结果单纯CEUS诊断的敏感度、特异度、准确率分别为71.43%、53.13%、62.69%;超声BI-RADS分类诊断的敏感度、特异度、准确率分别为88.57%、56.25%、73.13%;BIRADS分类结合CEUS诊断的敏感度、特异度、准确率分别为88.57%、93.75%、91.04%。结论BI-RADS分类联合CEUS可以提高乳腺可疑恶性病灶的诊断准确率。     

基于深度学习人工智能辅助系统用于CT检出肋骨新鲜骨折

目的 观察基于深度学习的人工智能(AI)辅助系统用于CT检出肋骨新鲜骨折的效能。方法 由2名高年资影像科医师对1 000例急诊CT所示肋骨新鲜骨折患者进行逐层标注,再由另2名高年资医师进行审核;将图像导入深睿医疗Dr.Wise^®骨折CT影像辅助检测系统(简称Dw_AI)。于1 000例中随机抽取60例(40例肋骨新鲜骨折、20例无骨折)作为数据集2,以其余940例为数据集1(902例肋骨新鲜骨折、38例无骨折)。由1名影像科主任医师(CR)基于数据集1独立评估肋骨新鲜骨折,将其结果与Dw_AI结果进行对比,评估Dw_AI的效能。由2名低年资和2名中等年资医师参与多阅片者多病例(MRMC)临床试验,基于数据集2,分别于病灶、肋骨和患者级别评估Dw_AI辅助不同年资医师诊断的效能。结果 数据集1 全部940例中, 2 946支肋骨存在3 452处新鲜骨折;Dw_AI对各级别肋骨新鲜骨折的敏感度均高于CR(P均＜0.05)。数据集2全部60例中,112支肋骨存在123处新鲜骨折;Dw_AI辅助下,不同年资医师诊断各级别肋骨新鲜骨折的敏感度均有所提高(P均＜0.05)。结论 AI辅助系统用于CT检出肋骨新鲜骨折的效能较佳,且能提高医师、尤其低年资医师的诊断敏感度。     

乳腺X线摄影对临床体检及超声检查阴性、X线摄影可疑病灶用外科干预的指导意义

目的:探讨乳腺影像报告及数据系统(BI-RADS)对临床体检及超声检查阴性、乳腺X线摄影可疑阳性的乳房病灶用外科干预的指导意义。方法:对乳腺X线摄影提示存在可疑病灶,而临床无法扪及明显肿块且超声检查阴性的病人,进行乳腺X线立体定位,作手术活检或真空辅助微创旋切活检,以明确可疑病灶的病理诊断。使用卡方检验或确切概率法检验,比较不同BI-RADS分类间恶性疾病发生率的差异;组间两两比较采用卡方分割法。结果:180例病灶中,BI-RADS分类属4A类者为92例,4B类者为64例,4C类者为24例。有23例病灶证实为恶性病变,其中2例(8.7%)为4A类,9例(39.1%)为4B类,12例(52.3%)为4C类。卡方检验发现,不同BI-RADS分类组之间,恶性病例的发生率有统计学差异(P<0.001)。结论:对于乳腺X线摄影检查为唯一阳性结果的乳腺病灶,BI-RADS分类系统对是否应予外科干预有指导意义。BI-RADS属4A类病灶可行短期随访;属4B或4C类病灶需进一步作外科活检以明确诊断。     

乳腺影像报告与数据系统对临床触诊阴性乳腺病灶分类的价值

目的探讨乳腺影像报告与数据系统(breast imaging reporting and data system,BI-RADS)对于临床触诊阴性乳腺病灶分类的意义及指导乳腺病灶活检的价值。方法由X线摄影发现的触诊阴性乳腺病灶162个,按照美国放射学会制定的第四版BI-RADS对其分类,所有病灶均采用金属线定位活检技术获得组织学诊断。结果全组162个触诊阴性病灶中,确认乳腺癌46个,阳性预测值为28.4%。按照BI-RADS分类,2类病灶11例,其中癌0例;3类病灶55例,癌2例;4类病灶77例,癌29例;5类病灶19例,癌15例;BI-RADS2-5类病灶癌的阳性预测值分别为0%,3.6%,37.7%与78.9%。结论BI-RADS分类大大提高了触诊阴性乳腺病灶影像诊断的特异性,可用于指导活检指征的选择,建议对BI-RADS4类与5类病灶进行活检,以提高触诊阴性乳腺病灶活检的阳性率。     

自动乳腺全容积扫查系统的临床应用

目的探讨自动乳腺全容积扫查（ABVS）系统检查乳腺病变的临床意义。方法应用AcusonS2000ABVS系统对81例患者双侧乳房进行扫查,包括正中位、内侧位和外侧位,获得横切面基本图像数据,系统自动进行三维重建,同步获得整个乳腺包括矢状面和冠状面的图像。由2位不同年资医师分别独立阅片。患者同时接受常规超声检查,比较两种检查的诊断结果。结果低年资和高年资医师采用ABVS系统发现的病灶数分别为89个、99个,采用常规超声发现的病灶数分别为60个、85个。采用ABVS系统时,不同年资医师的检查结果差异无统计学意义（P〉0.05）。结论 AB-VS系统可明显减少操作者经验对检查结果的影响,提高乳腺病变的检出率。     

超声检测乳腺癌微小钙化的影响因素及与钼靶X线摄影的对比

【摘要】〓目的〓比较超声与钼靶X线摄影检测乳腺癌微小钙化的一致性,探讨影响超声检测乳腺癌微小钙化的影响因素。方法〓87例乳腺癌行超声及钼靶X线摄影检查,分析二者的乳腺病灶及微小钙化的特点,比较二者检测的一致性,分析超声检测微小钙化的影响因素。结果〓超声对病灶的显示率及诊断恶性的准确率均高于钼靶(χ2=9.911,P=0.002)。二者在微小钙化的检出方面无统计学差异(P>0.05),具有较高的一致性(k=0.652)。以钼靶显示微小钙化作为标准,超声检测微小钙化的敏感度为82.1%,特异度为83.3%,假阳性率16.7%,假阴性率为17.9%。钼靶上微小钙化的大小及密集程度影响其超声检测(P<0.05)。结论〓超声较钼靶X线摄影能更敏感地检测及诊断乳腺恶性病变;超声能有效地检测乳腺癌微小钙化,但易受微小钙化的大小及密集程度的影响。     

MicroPure成像技术鉴别诊断乳腺良恶性肿瘤

目的评价MicroPure成像技术检测乳腺肿瘤微钙化及鉴别乳腺良恶性肿瘤的价值。方法对经钼靶x线检查证实存在微钙化灶的110例乳腺肿瘤患者（125个肿瘤）进行常规高频超声及配有MicroPure成像技术的超声检查,记录微钙化灶检出率,对乳腺肿瘤进行BI-RADS分级。以术后病理结果为金标准,比较常规高频超声及MicroPure成像技术诊断乳腺恶性肿瘤的准确率;绘制ROC曲线,比较两种方法诊断乳腺恶性肿瘤的能力。结果MicroPure成像技术对于微钙化的检出率（125／125,100％）高于常规高频超声（97／125,77．60％,χ2=29．32,P〈0．05）。对低回声病灶的微钙化,MicroPure成像技术的检出率（69／69,100％）与常规高频超声（67／69,97．10％）差异无统计学意义（χ2=0．507,P〉0．05）;而对非低回声病灶的微钙化,MicroPure成像技术的检出率（56／56,100％）明显高于常规高频超声（30／56,53．57％,χ2=31．31,P〈0．05）。MicroPure成像技术诊断乳腺恶性肿瘤的特异度、敏感度及准确率分别为86．21％（50／58）、95．52％（64／67）、91．20％（114／125）,常规高频超声则分别为86．21％（50／58）、74．63％（50／67）和80．00％（100／125）,二者诊断敏感度和准确率差异有统计学意义（P均〈0．05）。MicroPure成像技术诊断乳腺恶性肿瘤ROC曲线下面积（0．944）大于常规高频超声（0．859）。结论MicroPure成像技术可提高乳腺病灶微钙化的检出率,进而提高诊断乳腺恶性肿瘤的敏感度和准确率。     

X线引导下乳腺穿刺活检对触诊阴性病变的诊断意义及其适应证

目的探讨X线引导下乳腺穿刺活检对于临床触诊阴性病变的诊断意义及其适应证。方法对84例乳腺X线摄影发现临床触诊阴性的乳腺病变患者进行术前三维立体钩丝定位术,并取得病理结果。对乳腺影像报告数据系统（BI-RADS）分类不同的良、恶性病变进行统计学分析。结果临床触诊阴性乳腺病变X线摄影表现为钙化、肿块、结构紊乱等。按BI-RADS分类,本组病变为3~5类,且以4类为主,占89.29%（75/84）。4B类与4C类病变恶性率差异无统计学意义（χ2=2.15,P〉0.05）,但显著高于4A类（χ2=101.7,P〈0.05）。结论对BI-RADS分类为4B以上病灶应进行X线引导下乳腺穿刺活检。     

基于深度学习的计算机辅助诊断系统检出DR胸部正位片中的骨折

目的 观察基于深度学习的计算机辅助诊断系统（DL-CAD）检出DR胸部正位片中骨折的效能及其对低年资放射科医师的辅助作用。方法 ①试验1：回顾性收集547例DR胸部正位片,其中361例存在胸部骨折（共983处骨折）、186例无胸部骨折,评估DL-CAD对骨折的预测性能。②试验2：随机选取试验1中的397例DR胸片,其中211例存在胸部骨折（共604处骨折）、186例无胸部骨折,记录并比较单独DL-CAD（1组）、单独低年资医师（2组）、DL-CAD辅助低年资医师（3组）、单独高年资医师（4组）的检出结果。结果 ①试验1：983处骨折中,DL-CAD识别出672处,正确识别641处,误诊31处,敏感度65.21%（641/983）,F值为77.46%;361例骨折患者中,DL-CAD识别出320例,正确识别314例,误诊6例,敏感度86.98%（314/361）,F值92.22%。②试验2：1、2、3、4组观察者检出骨折的敏感度分别为62.09%（375/604）、61.59%（372/604）、86.75%（524/604）和83.44%（504/604）,F值分别为75.38%、74.62%、90.74%及89.84%;3、4组检测效能均高于1、2组（P均<0.001）,而1组与2组间、3组与4组间差异均无统计学意义（P均>0.05）。结论 DL-CAD对DR胸部正位片中骨折的检出效果较好,且可有效提高低年资放射科医师对胸部骨折的检出效能。     

Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis

ObjectivesMammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature.MethodsMedline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I² statistic, stratified and sensitivity analyses.ResultsNine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84–2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52–2.21) increased. Both results were statistically significant and homogenous.ConclusionsMammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.     

Comparison of breast density assessment between human eye and automated software on digital and synthetic mammography: Impact on breast cancer risk

PurposeTo evaluate the agreement between automatic assessment software of breast density based on artificial intelligence (AI) and visual assessment by a senior and a junior radiologist, as well as the impact on the assessment of breast cancer risk (BCR) at 5 years.Materials and methodsWe retrospectively included 311 consecutive women (mean age, 55.6 ± 8.5 [SD]; range: 40–74 years) without a personal history of breast cancer who underwent routine mammography between January 1, 2019 and February 28, 2019. Mammographic breast density (MBD) was independently evaluated by a junior and a senior reader on digital mammography (DM) and synthetic mammography (SM) using BI-RADS (5th edition) and by an AI software. For each MBD, BCR at 5 years was estimated per woman by the AI software. Interobserver agreement for MBD between the two readers and the AI software were evaluated by quadratic κ coefficients. Reproducibility of BCR was assessed by intraclass correlation coefficient (ICC).ResultsAgreement for MBD assessment on DM and SM was almost perfect between senior and junior radiologists (κ = 0.88 [95% CI: 0.84–0.92] and κ = 0.86 [95% CI: 0.82–0.90], respectively) and substantial between the senior radiologist and AI (κ = 0.79; 95% CI: 0.73–0.84). There was substantial agreement between DM and SM for the senior radiologist (κ = 0.79; 95% CI: 0.74–0.84). BCR evaluation at 5 years was highly reproducible between the two radiologists on DM and SM (ICC = 0.98 [95% CI: 0.97–0.98] for both), between BCR evaluation based on DM and SM evaluated by the senior (ICC = 0.96; 95% CI: 0.95–0.97) or junior radiologist (ICC = 0.97; 95% CI: 0.96–0.98) and between the senior radiologist and AI (ICC = 0.96; 95% CI: 0.95–0.97).ConclusionThis preliminary study demonstrates a very good agreement for BCR evaluation based on the evaluation of MBD by a senior radiologist, junior radiologist and AI software.     

Positive predictive value of BI-RADS categorization in an Asian population

The Breast Imaging Reporting And Data System (BI-RADS) categorization of mammograms is useful in estimating the risk of malignancy, thereby guiding management decisions. However, in Asian women, in whom breast density is increased, the sensitivity of mammography is correspondingly lower. We sought to determine the positive predictive value of BI-RADS categorization for malignancy in our Asian population and, hence, its value in helping us to choose between the various modalities for breast biopsy. We retrospectively reviewed all patients with occult breast lesions detected on mammography or ultrasound who underwent needle-localization open breast biopsy (NLOB) in our institution over a 6-year period. There were 470 biopsies in 427 patients; 16% of lesions were malignant. The positive predictive value of BI-RADS 4 and 5 lesions for cancer was 0.27 and 0.84, respectively. While most BI-RADS 5 mass lesions were invasive cancers, the majority of calcifications in this category were in situ carcinomas. We conclude that BI-RADS remains useful in aiding decision-making for biopsy in our Asian population. Based on positive predictive values, we recommend percutaneous breast biopsy for initial evaluation of lesions categorized as BI-RADS 4 or less. For BI-RADS 5 lesions with microcalcifications, open surgical biopsy as a diagnostic and therapeutic procedure may be more appropriate. In the case of a BI-RADS 5 lesion associated with a mass, initial percutaneous biopsy may be useful for diagnosis, followed by a planned single-stage surgical procedure as necessary.     

A comparison of mammography and ultrasound in women with breast disease: a receiver operating characteristic analysis

The purpose of this study was to compare mammography and sonography, as well as their combination, for detecting breast tumors in symptomatic patients. The effects of age and hormonal status were also examined. From 1999 to 2007, 549 patients underwent 665 examination sessions (mammography and ultrasound). Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative. On pathology, 246 lesions were malignant and 419 were benign in the 549 patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) of mammography and sonography were 81.71% and 95.53%, 85.44% and 80.43%, 76.72% and 74.13%, 88.83% and 96.84%, and 0.886 and 0.948, respectively. The sensitivity and diagnostic accuracy among patients <50 years of age were significantly higher for sonography than for mammography (p < 0.05). The sensitivity and diagnostic accuracy among premenopausal or perimenopausal patients were significantly higher for sonography than for mammography (p < 0.05). The sensitivity among postmenopausal patients was significantly higher for sonography than for mammography (p < 0.05). The results of combined mammography and sonography were classified using American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). There were 244 positive and two negative examinations of malignant lesions, and 106 positive and 313 negative examinations of benign lesions. The diagnostic accuracy of the combination was significantly higher than that of mammography (p < 0.05) and similar to that of sonography (p > 0.05). Sonography had better sensitivity and diagnostic accuracy than mammography for diagnosing breast diseases, while their specificities were similar. The diagnostic accuracy of diagnostic sonography was significantly better than that of mammography among patients <50 years of age and premenopausal or perimenopausal patients. The combination of mammography and sonography increased the sensitivity and diagnostic accuracy.     

术中标本摄片用于乳腺可疑钙化病变组织活检

目的 观察术中标本摄片用于乳腺可疑钙化病变组织活检的价值。方法 对48例乳腺单发可疑钙化病变患者行X线三维立体定位引导活检术,对其中12例行核芯针穿刺活检(SCNB)、22例行真空辅助旋切活检(SVAB)、14例行导丝定位手术切检(SNLB),术中以标本摄影系统对组织标本行X线摄片,之后对标本中的钙化进行标记并送病理检查;评估标本摄片在3种活检方式中显示钙化的清晰度及组织学低估情况,观察SNLB术中标本摄片所示钙化数目及切缘状态,并与术前乳腺X线片进行比较。结果 所有标本均获得目标钙化组织。术中标本摄片显示钙化清晰度优于术前乳腺X线片,显示SNLB组织内钙化数量多于术前乳腺X线片。14例SNLB中,12个术中标本摄片显示切缘阴性,与术后病理结果一致;2个切缘阳性,且钙化呈多灶性分布,术中快速冰冻切片结果均为恶性并切缘阳性,手术计划由保乳手术改为乳腺癌改良根治术。SCNB、SVAB活检结果及SNLB术中冰冻切片结果与手术病理结果均一致。结论 术中标本摄片用于乳腺可疑钙化病变组织活检具有一定价值。     

Evaluation of physician performance using a concurrent-read artificial intelligence system to support breast ultrasound interpretation

PurposeThe purpose of this study was to compare the diagnostic performance and the interpretation time of breast ultrasound examination between reading without and with the artificial intelligence (AI) system as a concurrent reading aid.Material and methodsA fully crossed multi-reader and multi-case (MRMC) reader study was conducted. Sixteen participating physicians were recruited and retrospectively interpreted 172 breast ultrasound cases in two reading scenarios, once without and once with the AI system (BU-CAD™, TaiHao Medical Inc.) assistance for concurrent reading. Interpretations of any given case set with and without the AI system were separated by at least 5 weeks. These reading results were compared to the reference standard and the area under the LROC curve (AUCLROC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for performance evaluations. The interpretation time was also compared between the unaided and aided scenarios.ResultsWith the help of the AI system, the readers had higher diagnostic performance with an increase in the average AUCLROC from 0.7582 to 0.8294 with statistically significant. The sensitivity, specificity, PPV, and NPV were also improved from 95.77%, 24.07%, 44.18%, and 93.50%–98.17%, 30.67%, 46.91%, and 96.10%, respectively. Of these, the improvement in specificity reached statistical significance. The average interpretation time was significantly reduced by approximately 40% when the readers were assisted by the AI system.ConclusionThe concurrent-read AI system improves the diagnostic performance in detecting and diagnosing breast lesions on breast ultrasound images. In addition, the interpretation time is effectively reduced for the interpreting physicians.     

The role of tomosynthesis in breast cancer staging in 75 patients

ObjectivesCompare tomosynthesis to mammography, ultrasound, MRI, and histology for the detection and staging of BI-RADS 4–5 anomalies, as a function of breast composition, lesion location, size, and histology.Patients and methodsSeventy-five patients underwent mammography, tomosynthesis, ultrasound, and MRI. The diagnostic accuracy of the different examinations was compared.ResultsThe sensitivities for detection were as follows: 92.5% with MRI, 79% for ultrasound, 75% for tomosynthesis, and 59.5% for mammography. Tomosynthesis improves the sensitivity of mammography (P = 0.00013), but not the specificity. The detection of multifocality and multicentricity was improved, but not significantly. Tomosynthesis identified more lesions than mammography in 10% of cases and improved lesion staging irrespective of the density, but was still inferior to MRI. The detection of ductal neoplasia was superior with tomosynthesis than with mammography (P = 0.016), but this was not the case with lobular cancer. The visualization of masses was improved with tomosynthesis (P = 0.00012), but not microcalcifications. Tomosynthesis was capable of differentiating lesions of all sizes, but the smaller lesions were easier to see. Lesion sizes measured with tomosynthesis, excluding the spicules, concurred with histological dimensions. Spicules lead to an overestimation of the size.ConclusionIn our series, tomosynthesis found more lesions than mammography in 10% of patients, resulting in an adaption of the surgical plan.     

动态增强MRI定性诊断乳腺导管上皮非典型增生

目的 观察动态增强MRI（DCE-MRI）定性诊断乳腺导管上皮非典型增生（ADH）的价值。方法 回顾性分析经穿刺活检或局部切除组织活检诊断的64例乳腺单发ADH患者,以手术病理结果为金标准,比较恶性与良性病变患者临床资料及乳腺X线、DCE-MRI征象,分析DCE-MRI预测乳腺恶性ADH的效能。结果 64例乳腺单发ADH中,28例为恶性（恶性组）,36例非恶性（非恶性组）,组间活检方式、病灶最大径、MRI示乳腺实质背景强化（BPE）、乳腺X线表现差异均有统计学意义（P均<0.1）;将上述因素纳入Logistic多因素回归分析,结果显示仅BPE为乳腺恶性ADH的独立影响因素[OR=7.550,95%CI（1.575,36.197）,P=0.011]。DCE-MRI诊断BI-RADS 4A及以下者27例,其中3例为恶性;4A类以上（4B及4C）37例,25例为恶性,诊断敏感度89.29%（25/28）,特异度66.67%（24/36）,阳性预测值67.57%（25/37）,阴性预测值88.89%（24/27）。结论 DCE-MRI可用于定性诊断乳腺ADH;其所示中重度BPE为术后病理恶性的正相关因素。     

Shear wave elastography contribution in ultrasound diagnosis management of breast lesions

PurposeTo determine the diagnosis performance of shear wave elastography in the differentiation of benign and malignant breast lesions and the factors influencing the elasticity values. To suggest an appropriate management of breast lesions using the ultrasound-elastography combination.Patients and methodsMonocentric retrospective study of 167 breast lesions classified by conventional ultrasound as BI-RADS category 3 or higher that underwent an elastography study and histological analysis.ResultsThe analysis of qualitative parameters, according to the classification established in this study, allows us to obtain a sensitivity of 91.1% and a specificity of 92.3%. These values are very close to or better than the quantitative parameters Emax and Emean. Different Emax thresholds values were established based on the long axis of the lesion and its palpable character, which appeared to be significant factors influencing elasticity. The management of breast lesions by combining ultrasound and elastography, as proposed here, allows us to keep the sensitivity of an ultrasound (96%), while doubling its specificity (86.2% versus 43.1%).ConclusionWith the complementary nature of their performance, the combination of conventional ultrasound and shear wave elastography can improve the management of breast lesions. The qualitative classification proposed appears to be relevant assistance in lesion characterization.