Predictive Value of Elastography (Shear-Wave and Elasticity Index) in Differentiating Benign from Malignant Breast Lesions: A Retrospective Study in Peru

Abstract

Background. Evidence on the usefulness of quantitative elastography in the characterization of breast lesions remains limited in Latin America and scarce in Peru. This study aims to fill a relevant scientific gap by establishing specific cutoff points to optimize diagnostic interpretation and improve accuracy in differentiating benign from malignant lesions.

Patients and methods. / Materials and methods. An observational, retrospective, and analytical study was conducted in 189 patients who underwent breast elastography between October 2024 and September 2025. Clinical and radiological variables were analyzed. Bivariate tests and multivariate binary logistic regression were applied to identify independent predictors of malignancy. The cutoff points were determined via receiver operating characteristic (ROC) curve analysis.

Results. Of the 85 lesions with histopathological confirmation, 54 (63.5%) were malignant, and 31 (36.5%) were benign. Malignant lesions presented significantly greater values of the elastography index (2.5 vs. 1.9; p = 0.001) and SWE (53 vs. 43 kPa; p < 0.001). According to the adjusted model, the BI-RADS category remained the most relevant radiological predictor, suggesting that elastography values can be considered complementary for more accurate classification. The optimal SWE cutoff value of ≥ 47.5 kPa demonstrated acceptable diagnostic performance, with a sensitivity of 79.6% and specificity of 67.7%, indicating an adequate ability to distinguish between benign and malignant breast lesions.

Conclusions. This study represents one of the first examples of Peruvian evidence contributing scientific information on the application of quantitative elastography in the evaluation of breast lesions.

Key words: Breast elastography; Shear wave elastography; Elasticity index; BI-RADS; Breast neoplasms; Diagnostic ultrasonography; Peru.