Yale Medical Center, and the Northwestern
Implications for Patient
In the end, the question remains, how can
new technology have cost effective improvements on patient healthcare? Firm results of
reproducibility and superior correct lesion
classification from an imaging modality
that is inexpensive and widely available
could have some very big implications on
cost savings for hospitals and clinics.
First of all, if shear wave elastography in
conjunction with B-mode could correctly
reclassify a lesion that was suspicious on B-mode alone, from a BIRADS 4 to a BIRADS
3, this could have several implications on
the benefits in patient management. One
benefit could be the reduction of risk associated with invasive procedures and the
decrease in the related level of patient anxiety. Another benefit could involve an
increase in patient throughput as correct
lesion classification translates into diagnostic confidence for the physician and the
In the same manner, shear wave elastography technology shows great promise
for cost saving lesion treatment and follow
up. Tissue elasticity could become an
important criterion for guidance for surgeons who struggle to find lesion margins
and fight against recurrence because of
malignant cells left behind. Likewise, shear
wave elastography could prove to be an
important indicator of effectiveness with
drug treatment. Today, it is difficult to
quickly measure the efficiency of expensive
treatments on lesions without undertaking several expensive exams. There are
costs involved in these exams but also a
cost involved in waiting for the results and
risking the advancement of the disease.
Shear wave elastography could give new
hope to this area by rapidly visualizing tissue elasticity changes directly after the
administration of treatment. However,
studies need to be put into place to examine this aspect.
Finally, although ultrasound is seen
today as a diagnostic tool, its utility could
extend to screening. The results of the
American College of Radiology Imaging
Network National Breast Ultrasound Trial
(ACRIN 6666) found that annual screening
with ultrasound in addition to mammog-
raphy significantly improves the detection
of early breast cancer. 3 However, the study
also found that ultrasound as a screening
tool could increase the risk of false positive
findings. It is hopeful that knowledge of tis-
sue elasticity, as with shear wave elastogra-
phy, could alleviate this disadvantage by
increasing the specificity of the ultrasound
exam. If this were true, the financial impli-
cations would be numerous and extend
from reducing patient care time and extra
examinations to expense savings of early
1Ghosh K, Melton LJ, Suman VJ, et al. Breast
biopsy utilization: a population-based study.
Arch Intern Med. 2005;Jul 25;165( 14):1593–8.
2Cosgrove DO. Premiere presentation of clinical
benefits of ShearWaveTM elastography:
Worldwide breast trial results. Presented at:
European Congress of Radiology 2010;
March 5, 2010; Vienna, Austria.
3Berg WA, Blume JD, Cormack JB, et al. Combined screening with ultrasound and mammography vs mammography alone in
women at elevated risk of breast cancer.
JAMA. 2008 May 14;299( 18):2151–63.
David Cosgrove is emeritus professor of clinical
ultrasound, Imperial College School of Medicine,
consultant in radiology, Hammersmith Hospital,
London and lead investigator Assessment of the
Clinical Value of Shear Wave Elastography Study.