Diagnostic Utility of Quantitative Strain Elastography in Breast Lesions: A Comparative Evaluation of Distance Ratio and Strain Ratio

IntroductionAccurate characterization of breast masses is essential for appropriate clinical management and reduction of unnecessary invasive procedures.Quantitative strain elastography is a useful adjunct to conventional breast ultrasonography by providing an objective assessment of tissue stiffness.Although the strain ratio (SR) has been widely investigated, the diagnostic utility of the distance ratio (DR) remains relatively underexplored.This study aimed to evaluate the diagnostic utility of quantitative strain elastography in differentiating benign from malignant breast lesions, with particular emphasis on the comparative performance of the DR and SR, using histopathology as the reference standard. MethodsThis prospective cross-sectional study included 30 women presenting with palpable breast masses or lesions detected on sonomammography.All patients underwent conventional breast ultrasonography followed by quantitative strain elastography.The DR and SR were recorded and compared with histopathological findings.Receiver operating characteristic (ROC) analysis was performed to determine optimal cutoff values and evaluate the diagnostic performance of both parameters. ResultsHistopathological examination revealed 20 (66.7%) malignant and 10 (33.3%) benign breast lesions.The mean DR was significantly higher in malignant lesions than in benign lesions (1.60 ± 0.27 vs. 1.06 ± 0.11; p < 0.001).At a cutoff value of 1.23, the DR demonstrated 95% sensitivity, 100% specificity, 100% positive predictive value (PPV), 90.9% negative predictive value (NPV), and an overall diagnostic accuracy of 96.7%.The mean SR was also significantly higher in malignant than in benign lesions (7.41 ± 3.73 vs. 2.21 ± 1.05; p < 0.001).At a cutoff value of 3.61, the SR demonstrated 95% sensitivity, 90% specificity, and an overall diagnostic accuracy of 93.3%. ConclusionsBoth DR and SR demonstrated promising diagnostic performance in differentiating benign from malignant breast lesions in this cohort.Quantitative strain elastography may serve as an adjunct to conventional breast ultrasonography; however, the findings do not establish the superiority of either parameter.Larger studies involving independent cohorts are needed to validate the derived cutoff values and determine the reproducibility and clinical applicability of these parameters.