Elastography

Elastography (strain imaging) is a method of assessing the stiffness of tissue. Elastography aims to use the increased stiffness of malignant lesions compared with that of benign lesions to aid diagnosis. Invasive breast cancer contains disordered fetal collagen which makes lesions poorly compressible, whilst benign lesions such as fibroadenoma are less stiff even if they contain large amounts of collagen. This is because the collagen in fibroadenomas is well-ordered, adult type collagen.

A recent study has looked at the additional value of adding strain imaging to B-mode imaging when trying to differentiate benign from malignant breast masses. They detected a small but statistically significant improvement in the area under the ROC curve from 0.88 to 0.90, p = 0.01. However, there was considerable inter-observer variability, with image quality also affecting observer performance.¹⁶