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Diagnostic Directions: Evaluating the impact of ShearWave Elastography

July 31, 2016
What does SWE add to the
radiologist's diagnostic toolkit?
From the July 2016 issue of HealthCare Business News magazine

By Dr. Kamilia Kozlowski

Over the past two decades radiologists have witnessed the introduction of several new imaging technologies into the breast center, including digital mammography, magnetic resonance imaging (MRI), tomosynthesis and advanced ultrasound technologies. Incorporating these technologies in clinical practice is a decision that is not taken lightly. Finding the balance between efficacy and outcomes can be difficult to evaluate.

Factors to consider
For a clinical breast radiologist, keeping up with the latest technologies that can impact the ability to find early breast cancers is critically important. Ultrasound has been used for many years in the breast center, and clinical studies have demonstrated that adding ultrasound to mammography improves detection.

This improvement may come with a drawback — an increase in the number of false-positive results1. This increase in false-positives can lead to unnecessary biopsies, which can result in a reduction in diagnostic confidence for the radiologist and added stress for the patient.

One technological advance, ShearWave Elastography (SWE), has brought new appeal to how ultrasound can be used as a powerful tool within the breast center, without the shortcomings. SWE provides quantitative information about tissue elasticity to the breast radiologist. After fast-moving shear waves are sent through the tissue, their propagation speed is calculated, and a color-coded, real-time SWE map is produced showing quantitative (in kilopascals or m/s) local tissue stiffness. Quantification of the stiffness of the lesion and its surrounding tissue provides important information to the clinician. The ability to quantify tissue elasticity can have an impact on the Breast Imaging-Reporting and Data System (BI-RADS) classification, location and morphology of a specific lesion. As a result, the physician is able to use the information for more accurate diagnosis and planning.

Clinical impact
SWE provides critical data that has resulted in a reduction in the number of unnecessary biopsies, has helped prevent false negative diagnoses and has improved overall diagnostic confidence and patient management2, 3. In an effort to evaluate the impact of SWE on our clinical practice we compared data from before the addition of SWE with data post-SWE. The data demonstrates an increased yield of cancer diagnoses in ultrasound-only findings in women who have a negative mammogram.

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