Use of next-generation shear wave elastography for blue breast cancer evaluation

Abstract

Background: Blue breast cancer is a term used to describe breast nodules that appear deceptively soft (blue) on elastography despite their malignant nature-representing a significant diagnostic challenge in breast imaging.

Methods: This prospective study evaluates the efficacy of next-generation shear wave elastography (SWE) technology in the characterization of blue breast cancer through a comprehensive analysis of 150 prospective patients with BIRAD 4-5 solid breast nodules on routine sono-mammography on three different standard elastography systems i.e., Canon Aplio i 800, Mindray Resona i 9 and Siemens Sequoia system (next generation elastography).

Results: Our analysis reveals that Siemens next gen 2D-SWE algorithm demonstrated a 88.3% overall improvement in blue cancer detection rate (from 10.0% with Aplio to 98.3% with Sequoia, p<0.001) with a 98.3% reduction in false negatives. The Sequoia system achieved 98.3% sensitivity and 94.4% specificity compared to 0% sensitivity with Resona i9 and 10% sensitivity with Aplio i 800. Diagnostic accuracy increased from 58.7% (Aplio i800) and 53.3% (Resona i9) to 96.0% (Sequoia) (p<0.001) with excellent reproducibility (ICC>0.98).

Conclusions: Next-generation SWE technology significantly improves blue breast cancer evaluation across all breast densities and histological subtypes, with greatest impact in traditionally challenging scenarios. SWE>85 kPa measurement provides the most reliable diagnostic indicator with near-perfect performance (F1=0.992, AUC=0.992). As a complementary tool to B-mode ultrasound, it enhances clinical confidence in breast lesion assessment and may contribute to earlier cancer detection and improved patient outcomes.