Combined quantitative speed-of-sound imaging and shear-wave elastography for differentiating benign and malignant breast lesions: development of a multimodal ultrasound nomogram.
- 1Department of Ultrasound Center, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
- 2Guizhou Medical University, Guiyang, China.
Abstract
Accurate differentiation of benign and malignant breast lesions is essential for guiding clinical management and reducing unnecessary biopsies. However, conventional ultrasound alone often has limited specificity. This study aimed to evaluate the diagnostic performance of shear-wave elastography (SWE) and quantitative speed-of-sound (QSOS) imaging and to develop a multimodal ultrasound nomogram integrating quantitative imaging parameters with conventional ultrasound features for breast lesion characterization. This retrospective study included 108 breast lesions (43 malignant and 65 benign) from 108 women who underwent conventional B-mode ultrasound, SWE, and QSOS imaging before histopathological confirmation. Quantitative SWE and QSOS parameters were obtained from intralesional and perilesional regions. Imaging predictors associated with malignancy were selected through least absolute shrinkage and selection operator (LASSO) regression and subsequently evaluated using multivariable logistic regression analysis. Independent predictors were incorporated into a diagnostic nomogram. Model performance was assessed using receiver operating characteristic (ROC) curve analysis, DeLong test, calibration curves, bootstrap resampling (1,000 repetitions) for internal validation, and decision curve analysis (DCA). Malignant lesions exhibited significantly higher maximum elasticity (Emax) and QSOS values than benign lesions [Emax: 70.6±33.5 vs. 40.9±21.4 kPa; QSOS: 1,557.1 (1,535.8-1,564.9) vs. 1,529.7 (1,506.1-1,543.9) m/s; both P<0.001]. Multivariable analysis identified lesion size [odds ratio (OR) =1.12, 95% confidence interval (CI): 1.02-1.26, P=0.030], non-parallel orientation (OR =18.93, 95% CI: 2.00-303.26, P=0.019), calcification (OR =20.18, 95% CI: 3.44-187.76, P=0.002), Emax (OR =1.05, 95% CI: 1.02-1.10, P=0.007), and QSOS per 10 m/s increase (OR =1.71, 95% CI: 1.13-2.93, P=0.024) as independent predictors of malignancy. QSOS and Emax showed moderate diagnostic performance, with areas under the ROC curve (AUCs) of 0.776 and 0.775, respectively, whereas their combination improved the AUC to 0.850 (95% CI: 0.774-0.926). The multimodal nomogram integrating conventional ultrasound features, Emax, and QSOS achieved excellent discrimination (AUC =0.969; 95% CI: 0.943-0.994), with 88.4% sensitivity and 92.3% specificity. The nomogram significantly outperformed the conventional ultrasound model alone according to the DeLong test (P=0.030) and demonstrated favorable calibration and clinical utility. SWE and QSOS provide complementary quantitative information for breast lesion characterization. Integration of conventional ultrasound features with quantitative stiffness and sound-speed information in a multimodal nomogram demonstrated excellent diagnostic performance and may provide a quantitative adjunctive approach for improving breast lesion assessment and clinical decision-making.
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BibTeX
@article{liao2026combined,
title = {{Combined quantitative speed-of-sound imaging and shear-wave elastography for differentiating benign and malignant breast lesions: development of a multimodal ultrasound nomogram.}},
author = {Chunyan Liao and Lina Zhao and Dan Huang and Sha Li and Bei Zhang},
journal = {Quantitative imaging in medicine and surgery},
year = {2026},
month = sep,
doi = {10.21037/qims-2026-1339},
url = {https://europepmc.org/article/MED/42997928},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Combined quantitative speed-of-sound imaging and shear-wave elastography for differentiating benign and malignant breast lesions: development of a multimodal ultrasound nomogram.
AU - Chunyan Liao
AU - Lina Zhao
AU - Dan Huang
AU - Sha Li
AU - Bei Zhang
PY - 2026
DA - 2026/09/29
JO - Quantitative imaging in medicine and surgery
DO - 10.21037/qims-2026-1339
UR - https://europepmc.org/article/MED/42997928
AB - Accurate differentiation of benign and malignant breast lesions is essential for guiding clinical management and reducing unnecessary biopsies. However, conventional ultrasound alone often has limited specificity. This study aimed to evaluate the diagnostic performance of shear-wave elastography (SWE) and quantitative speed-of-sound (QSOS) imaging and to develop a multimodal ultrasound nomogram integrating quantitative imaging parameters with conventional ultrasound features for breast lesion characterization. This retrospective study included 108 breast lesions (43 malignant and 65 benign) from 108 women who underwent conventional B-mode ultrasound, SWE, and QSOS imaging before histopathological confirmation. Quantitative SWE and QSOS parameters were obtained from intralesional and perilesional regions. Imaging predictors associated with malignancy were selected through least absolute shrinkage and selection operator (LASSO) regression and subsequently evaluated using multivariable logistic regression analysis. Independent predictors were incorporated into a diagnostic nomogram. Model performance was assessed using receiver operating characteristic (ROC) curve analysis, DeLong test, calibration curves, bootstrap resampling (1,000 repetitions) for internal validation, and decision curve analysis (DCA). Malignant lesions exhibited significantly higher maximum elasticity (Emax) and QSOS values than benign lesions [Emax: 70.6±33.5 vs. 40.9±21.4 kPa; QSOS: 1,557.1 (1,535.8-1,564.9) vs. 1,529.7 (1,506.1-1,543.9) m/s; both P<0.001]. Multivariable analysis identified lesion size [odds ratio (OR) =1.12, 95% confidence interval (CI): 1.02-1.26, P=0.030], non-parallel orientation (OR =18.93, 95% CI: 2.00-303.26, P=0.019), calcification (OR =20.18, 95% CI: 3.44-187.76, P=0.002), Emax (OR =1.05, 95% CI: 1.02-1.10, P=0.007), and QSOS per 10 m/s increase (OR =1.71, 95% CI: 1.13-2.93, P=0.024) as independent predictors of malignancy. QSOS and Emax showed moderate diagnostic performance, with areas under the ROC curve (AUCs) of 0.776 and 0.775, respectively, whereas their combination improved the AUC to 0.850 (95% CI: 0.774-0.926). The multimodal nomogram integrating conventional ultrasound features, Emax, and QSOS achieved excellent discrimination (AUC =0.969; 95% CI: 0.943-0.994), with 88.4% sensitivity and 92.3% specificity. The nomogram significantly outperformed the conventional ultrasound model alone according to the DeLong test (P=0.030) and demonstrated favorable calibration and clinical utility. SWE and QSOS provide complementary quantitative information for breast lesion characterization. Integration of conventional ultrasound features with quantitative stiffness and sound-speed information in a multimodal nomogram demonstrated excellent diagnostic performance and may provide a quantitative adjunctive approach for improving breast lesion assessment and clinical decision-making.
SN - 2223-4292
SN - 2223-4306
ER -