Evaluating shear wave elastography for differentiating lipomas from low to intermediate grade liposarcomas: is it reproducible and reliable?.

Ooi, MWX.; Wilson, M.; Nicholls, J.; Pass, B.; Gupta, H.; Hensor, E.; Robinson, P.

Evaluating shear wave elastography for differentiating lipomas from low to intermediate grade liposarcomas: is it reproducible and reliable?.

All Authors

Ooi, MWX.

Wilson, M.

Nicholls, J.

Pass, B.

Gupta, H.

Hensor, E.

Robinson, P.

LTHT Author

Ooi, Michelle Wei Xin
Wilson, Michelle
Gupta, Harun
Hensor, Elizabeth
Robinson, Philip

LTHT Department

Radiology
NIHR Leeds Biomedical Research Centre

Publication Date

2025

Item Type

Journal Article

Abstract

OBJECTIVE: To evaluate if imaging findings and shear wave elastography (SWE) can differentiate between lipoma and low-to-intermediate grade liposarcoma and to assess for SWE reproducibility across different manufacturer machines. MATERIALS AND METHODS: Consecutive patients referred for lipomatous soft tissue mass biopsy prospectively underwent B-mode ultrasound (US), SWE on two machines (LOGIQ-E9 and SSI-Aixplorer), and MRI. Three musculoskeletal radiologists independently scored images and gave an assessment of malignancy on a four-point scale. Inter-reader agreement was evaluated with kappa statistic (US/US + MRI) and ICC (SSI-Aixplorer velocity/stiffness; cross-machine comparisons). Diagnostic utility of shear wave velocity (SWV) was evaluated using area under receiver operating characteristic (AUROC) curve against pathology. RESULTS: Among 269 patients (mean age 58.8 +/- 15.7 years, 34.6% (93/269) female), 22% (59/269) of lesions were malignant. Inter-reader agreement on SSI-Aixplorer was good for velocity and stiffness with ICC 0.87 (95% CI 0.75-0.94) and 0.93 (95% CI 0.87-0.97) respectively. Agreement between machines was moderate for velocity and stiffness with ICC 0.62 (95% CI 0.53-0.69) and 0.66 (95% CI 0.58-0.73) respectively. SWV poorly predicted malignancy (AUROC 0.57, 95% CI 0.49-0.65), and failed to differentiate benign from malignant lipomatous tumours at previously defined 2.02 m/s threshold, misclassifying 9.5% (4/42) as benign. SWV failed to further stratify radiologist grouped benign/probably benign lesions on US (AUROC 0.59, 95% CI 0.49-0.68). Using MRI to further stratify lesions classified as benign/probably benign on US with SWV <= 2.02 m/s had a sensitivity of 61.8% and specificity of 80.2%. CONCLUSION: SWE did not enhance diagnostic accuracy in differentiating lipoma from low-to-intermediate grade liposarcoma and lacked reproducibility across different machines.