DIAGNOSTIC ACCURACY OF ULTRASOUND ELASTOGRAPHY IN FOCAL BREAST LESIONS KEEPING HISTOPATHOLOGY AS GOLD STANDARD: A CROSS-SECTIONAL STUDY

Background: Breast cancer frequently presents as a focal breast lesion, and accurate non-invasive characterization remains essential to guide clinical decision-making and avoid unnecessary biopsies. Conventional B-mode ultrasonography, although sensitive, has limited specificity, particularly in women with dense breast tissue. Ultrasound elastography evaluates tissue stiffness and has emerged as a promising adjunct technique to improve lesion characterization. Shear wave elastography provides quantitative elasticity measurements, potentially enhancing diagnostic confidence, especially in resource-limited settings where reducing invasive procedures is clinically and economically important. Objective: To determine the diagnostic accuracy of shear wave elastography in differentiating benign and malignant focal breast lesions using histopathology as the reference standard. Methods: A cross-sectional diagnostic accuracy study was conducted on 100 consecutive women presenting with focal breast lesions confirmed on B-mode ultrasound. All participants underwent shear wave elastography prior to tissue diagnosis. Quantitative stiffness measurements were recorded, and lesions were classified as benign or malignant based on predefined elasticity thresholds. Histopathology or fine-needle aspiration cytology served as the gold standard. Diagnostic performance parameters, including sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy, were calculated. Stratified analyses were performed to assess the influence of age, body mass index, and marital status. Results: Histopathological examination identified malignant lesions in 31% and benign lesions in 69% of cases. Shear wave elastography categorized 30% of lesions as malignant and 70% as benign. Compared with histopathology, elastography demonstrated a sensitivity of 74.2%, specificity of 89.9%, positive predictive value of 76.7%, negative predictive value of 88.6%, and an overall diagnostic accuracy of 85.0%. The highest accuracy was observed in women aged 25–40 years (89.7%), followed by those older than 40 years (84.8%) and younger than 25 years (80.0%). Diagnostic accuracy was slightly higher in participants with body mass index ≤25 kg/m² compared with those above this threshold. High specificity was consistently maintained across all subgroups. Conclusion: Shear wave elastography demonstrated good diagnostic accuracy and high specificity in distinguishing benign from malignant focal breast lesions. Its integration with conventional ultrasonography can enhance diagnostic confidence and support reduction of unnecessary biopsies, particularly in settings with limited resources.