Ultrasound Strain Elastography for Soft Tissue Tumor Evaluation

This study aimed to evaluate the utility of elastography in assessing a wide range of superficial soft tissue lesions, using the Asteria elastographic scoring (ES) system. Forty patients with various soft tissue lesions, including lipomas, schwannomas, neuromas, epidermal inclusion cysts, melanoma metastasis, arterio-venous malformations, and giant-cell tumors, were examined using ultrasound combined with color-Doppler and elastography. The lesions were classified based on B-mode criteria (echogenicity, margins, homogeneity), vascularization, and elastographic scores (ES1-4) corresponding to increasing tissue stiffness. The findings were correlated with clinical or histopathological results. Elastography alone showed a sensitivity of 87%, specificity of 94%, and diagnostic accuracy of 90%. The combination of hypoechoic appearance with ES3/ES4 had the best diagnostic performance, achieving 100% specificity and a positive predictive value (PPV). However, elastography alone was not sufficient for definitive diagnosis, as combining B-mode criteria and elastography provided the best diagnostic accuracy. The study highlights the importance of using elastography as an additional tool in ultrasound evaluations of superficial soft tissue lesions, but it should not replace comprehensive imaging and clinical assessments. The combined use of B-mode ultrasound and elastography improves diagnostic precision, especially for distinguishing benign from malignant lesions.