Role of strain elastography in the diagnosis of superficial soft-tissue lesions

Abstract

Background: Elastography, recent progress in the field of imaging, is an innovative approach which provides information pertaining to tissue elasticity. Charting the stiffness can be performed either by assessing the same, using the evaluation of the strain i n the mass of cells in the presence of stress or assessment of shear waves, the propagation of which is dependent on the tissue stiffness, using imaging tools. This study was done to investigate the validity of strain elastography in the diagnosis of superficial soft-tissue lesions in contrast to histopathological examination (HPE) due to the dearth of studies comparing strain elastography and HPE, particularly in the Indian context. Materials and Methods: The present longitudinal study was conducted by the Department of Radiology at AVBRH, Sawangi, Wardha, from the year 2020 to 2022. Ninety-six subjects who were diagnosed or clinically suspected superficial soft-tissue lesions irrespective of age and gender were included. All patients underwent ultrasound, elastography, and final diagnosis was confirmed with HPE. Institutional Ethical Clearance (No: DMIMS [DU]/IEC/2022/340) and before the initiation of the investigation and the recruitment of patients into the study, informed consent was obtained. Chi-square test, Mann–Whitney U-test, and Kruskal–Wallis test were the tests of significance. Results: The subjects' average age was 40.38 ± 18.95 years, and 57.3% of them were women. On HPE, 21 lesions (21.8%) were categorized as malignant and 75 lesions (77.2%) as benign. The mean strain ratio (SR) was 11.7 ± 4.8 for malignant lesions and 2.5 ± 4.6 for benign lesions. Malignant and benign lesions had a noticeable change in SR. To distinguish between malignant and benign soft-tissue lesions, an SR of >3 had a sensitivity of 95.24%, specificity of 91.89%, positive predictive value of 87.0%, and negative predictive value of 97.1%. Conclusion: SR of malignant lesions was higher than that of benign soft-tissue lesions. SRs performed better as a diagnostic tool than elasticity scores hence, SRs can be utilized as a marker to foretell a soft-tissue tumor's propensity for malignancy.