Interobserver Variability of Ultrasound Elastography: How It Affects the Diagnosis of Breast Lesions

Interobserver Variability of Ultrasound Elastography: How It Affects the Diagnosis of Breast Lesions
Jung Hyun Yoon, Myung Hyun Kim, Eun-Kyung Kim, Hee Jung Moon, Jin Young Kwak, and Min Jung Kim
AJR 2011; 196:730-736

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Of the 65 lesions, 43 (66.2%) were benign, and 22 (33.8%) were malignant. Specificity (20.2–33.3%), positive predictive value (38.7–45.1%), and accuracy (46.7–55.4%) were significantly improved in combined ultrasound and elastography (p < 0.001). Area under the curve (AUC) values for all three performers did not show significant differences in ultrasound (AUC, 0.959) and combined ultrasound and elastography (AUC, 0.957) (p = 0.92). Interobserver agreement was not improved with combined ultrasound and elastography ( = 0.25) in comparison to ultrasound only ( = 0.37). Interobserver agreement of real-time elastography was fair in both fat-to-lesion ratio (intraclass correlation coefficient score, 0.25) and elasticity score ( = 0.28). Moderate agreement ( = 0.46) was seen with static elastography.

Elastography improves the specificity, positive predictive value, and accuracy of ultrasound. However, significant interobserver variability exists, with real-time elastographic performance showing fair agreement.