Transthoracic ultrasound shear-wave elastography: can it play a role in assessing peripheral lung lesions?

Abstract Background Ultrasound elastography has various applications in different fields of medicine with encouraging outcomes. Theoretically, transthoracic pleural two-dimensional shear-wave elastography (2D-SWE) could aid in differentiating benign peripheral lung lesions from malignant lesions thr...

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Main Authors: Manal A. Mahmoud, Samiaa Hamdy Sadek, Ramy Mohammed Ahmed, Asmaa Abdeltawab, Waleed Gamal Elddin Khaleel
Format: Article
Language:English
Published: SpringerOpen 2025-06-01
Series:The Egyptian Journal of Bronchology
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Online Access:https://doi.org/10.1186/s43168-025-00408-z
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Summary:Abstract Background Ultrasound elastography has various applications in different fields of medicine with encouraging outcomes. Theoretically, transthoracic pleural two-dimensional shear-wave elastography (2D-SWE) could aid in differentiating benign peripheral lung lesions from malignant lesions through adding accurate information about tissue stiffness to B-mode gray scale ultrasound obtained images. A cross-sectional study was conducted to evaluate the predictive value of 2D-SWE for diagnosing peripheral lung lesions. Forty-seven patients with a peripheral pulmonary lesion illustrated by radiography were enrolled. 2D-SWE was conducted to assess the lesions of interest. The elasticity of subpleural lung lesions was measured and expressed as shear-wave velocity (m/s) and shear-wave elasticity (kPa). Final diagnoses were made on the basis of pathology report for either sonographic or computed tomography (CT)-guided or bronchoscopic biopsy if indicated and/or microbiological studies. Results Majority (83%) of included patients were males. Mean age for study participants was 55.34 ± 14.47 years. Demographic and baseline data for patients exhibiting malignant lesions versus those with non-malignant lesions showed no significant differences. Mean value for shear-wave elasticity (SWE) and shear-wave velocity (SWV) were significantly higher among patients with malignant lesions versus patients with non-malignant lesions (46.7 ± 29.9 kPa vs. 16.4 ± 10.6 kPa for SWE; 3.7 ± 1.2 m/s vs. 2.24 ± 0.68 m/s for SWV). ROC curve analysis was used to identify the cut-off value regarding shear-wave elasticity and velocity for predicting malignant peripheral lung lesions. SWE at the cut-off value of 20.33 kPa showed 81.8% sensitivity, 76% specificity, and 0.86 area under the curve (AUC). While, SWV at cut-off value of 2.6 m/s, the sensitivity was 81.8% and the specificity was 76% with 0.855 AUC. Conclusions Transthoracic shear-wave ultrasound elastography can be applied as a promising tool for assessing unidentified and difficult-to-diagnose peripheral lung lesions. A cutoff point of 20.33 kPa for shear-wave elasticity and 2.6 m/s for shear-wave velocity is suggested for predicting lung malignancy in peripheral lung lesions. Trial registration NCT05759390. Registered February 26, 2023.
ISSN:2314-8551