The value of ultrasound viscosity imaging in preoperative differential diagnosis between malignant and benign breast lesions: Preliminary clinical applications.

Objective: To investigate the value of ultrasound viscosity imaging in preoperative differential diagnosis between malignant and benign breast lesions.

Methods: This prospective study was approved by our institutional review board and informed consents were signed by all patients. Patients diagnosed with focal solid breast lesions who plan to undergo surgical or ultrasound guided core needle biopsy were included. A Mindray Resona R9 Elite diagnostic ultrasound system equipped with a linear array transducer (L15-3 MHz) was used. First BMUS was used to identify the lesions, afterwards, ultrasound viscosity imaging and shear wave elastography measurements were performed for each lesion. Viscosity (Pa*s) coefficient and shear-wave speed (m/s) of each breast lesion were measured. Taking the final histopathological results as the gold standard, the optimal cut-off value of viscosity and elastography values in differential diagnosis between malignant and benign breast lesions were evaluated. Diagnostic performance was assessed by using the area under the receiver operating characteristic curve (ROC).

Results: From July 2023 to March 2024, 159 consecutive patients with a total of 184 solid breast lesions were included. Among which 74 (40.2%) malignant lesions and 110 (59.8%) benign ones were diagnosed according to the final histopathological results. The mean maximal viscosity coefficient (7.56±3.63 Pa*s) of malignant lesions was significantly higher than that of benign ones (4.52±2.33 Pa*s), whereas the mean maximal SWE value (6.53±1.87 m/s) of malignant lesions was also obviously higher than that of benign ones (4.80±1.62 m/s) (P < 0.05). The cut-off value for diagnosis of malignant breast tumors was 5.39 Pa*s for viscosity, with 75.68% sensitivity, 68.18% specificity and 0.763 AUROC (P < 0.05). When combined viscosity with SWE values, the sensitivity and specificity was 75.68% and 75.45%, with an-area under the receiver operating characteristic curve (AUC) 0.787.

Conclusions: The value of viscosity measurement may provide additional value for preoperative non-invasive differential diagnosis between malignant and benign breast lesions.