Advanced Ultrasound Improves Soft Tissue Tumour Assessment

Advanced ultrasound techniques that assess tissue stiffness and microvascular blood flow could improve differentiation between benign and nonbenign soft tissue tumours (STTs), according to new research.

Researchers found that shear-wave elastography (SWE) and superb microvascular imaging (SMI) provided additional diagnostic information beyond conventional B-mode ultrasound. When imaging measures were combined, diagnostic performance reached an area under the receiver operating characteristic curve (AUC) of 0.87.

Distinguishing Benign from Nonbenign Tumours

Accurately determining whether an STT is benign or potentially malignant remains challenging, with conventional ultrasound alone often unable to provide sufficient discrimination.

Researchers conducted a retrospective diagnostic accuracy study involving 167 consecutive patients referred for STT biopsy at a tertiary centre between February 2022 and July 2023. Histological examination was used as the reference standard.

Alongside conventional B-mode ultrasound measurements, investigators assessed lesions using SWE, which provides information about tissue stiffness, and SMI, which enables assessment of microvascularity.

Tumour Stiffness and Microvascularity Differ

Both SWE and SMI measurements were significantly higher among nonbenign lesions.

Mean SWE values were 4.00 m/sec in nonbenign tumours compared with 2.65 m/sec in benign tumours (P<0.001). Similarly, mean SMI values were 31.5% and 6.2%, respectively (P<0.001).

Tumour dimensions also differed. Mean deepest diameter was 4.57 cm among nonbenign lesions compared with 2.55 cm among benign lesions, while the deepest-to-largest diameter ratio was 0.51 versus 0.37 (both P<0.001).

When evaluated individually, SMI achieved an AUC of 0.82, with 71% sensitivity and 87% specificity. SWE achieved an AUC of 0.75, with 75% sensitivity and 71% specificity.

Combining Ultrasound Measures Boosts Accuracy

Diagnostic performance improved further when researchers combined lesion dimensions with SWE and SMI measurements, producing an AUC of 0.87.

The findings suggest that incorporating measures of tumour stiffness and microvascularity into conventional ultrasound assessment could provide clinicians with additional information when evaluating suspicious soft tissue lesions.

The researchers concluded that both SWE and SMI improved diagnostic accuracy in STT evaluation, supporting the potential value of multimodal ultrasound for distinguishing benign from nonbenign lesions.