Shear wave elastography for breast masses is highly reproducible

Objectives To evaluate intra- and interobserver reproducibility of shear wave elastography (SWE) for breast masses. Methods For intraobserver reproducibility, each observer obtained three consecutive SWE images of 758 masses that were visible on ultrasound. 144 (19%) were malignant. Weighted kappa was used to assess the agreement of qualitative elastographic features; the reliability of quantitative measurements was assessed by intraclass correlation coefficients (ICC). For the interobserver reproducibility, a blinded observer reviewed images and agreement on features was determined. Results Mean age was 50 years; mean mass size was 13 mm. Qualitatively, SWE images were at least reasonably similar for 666/758 (87.9%). Intraclass correlation for SWE diameter, area and perimeter was almost perfect (ICC >= 0.94). Intraobserver reliability for maximum and mean elasticity was almost perfect (ICC=0.84 and 0.87) and was substantial for the ratio of mass-to-fat elasticity (ICC=0.77). Interobserver agreement was moderate for SWE homogeneity (kappa=0.57), substantial for qualitative colour assessment of maximum elasticity (kappa=0.66), fair for SWE shape (kappa=0.40), fair for B-mode mass margins (kappa=0.38), and moderate for B-mode mass shape (kappa=0.58), orientation (kappa=0.53) and BI-RADS assessment (kappa=0.59). Conclusions SWE is highly reproducible for assessing elastographic features of breast masses within and across observers. SWE interpretation is at least as consistent as that of BI-RADS ultrasound B-mode features. Key Points Shear wave ultrasound elastography can measure the stiffness of breast tissue It provides a qualitatively and quantitatively interpretable colour-coded map of tissue stiffness Intraobserver reproducibility of SWE is almost perfect while intraobserver reproducibility of SWE proved to be moderate to substantial The most reproducible SWE features between observers were SWE image homogeneity and maximum elasticity