OBJEVTICES: Shearwave elastography has recently got approval for its use in clinical imaging.
It has got its established accuracy in assessing liver fibrosis, where biopsy for the staging of
cirrhosis has been minimized. There is emerging data showing its superiority in detecting
breast and other cancers as compared to conventional imaging methods. This study aimed to
analyse role of shearwave elastography in detection of primary impalpable lesions in breast and
abdomino-pelvic regions and those missed on conventional imaging modalities.
SETTING: Shearwave Elastography Unit, Liaquat University of Medical & Heath Sciences,
DESIGN & METHODS: The study is an observational pilot project including the patients presented
to surgery and oncology departments with metastatic cancer suggested on conventional
imaging or cytology of the metastatic site but primary sites were not known and suspected to
be in the region of breast, abdomen or pelvis. Shearwave elastography was applied as supplementary
tool to re-do B-mode ultrasound. Aixplorer Ultrasound System Multiwave version 8.2.0
(Supersonic Imagine S.A., Aix-en-Provence, France) was used in this study. This study selectively
includes the patients who were called on experimental basis to see the effectiveness of
the system on trial basis, the calculation of the sensitivity, specificity, positive predictive value
and negative predictive values were not determined.
RESULTS: There were seven patients including four with axillary lymph nodes and three having
liver metastases. In patients with axillary lymph nodes mammogram and conventional ultrasound
failed to show primary breast lesions, histopathology of the axillary lymph nodes suggested
infiltrating ductal carcinoma. In patients with liver metastases conventional ultrasound
abdomen and CT scan failed to reveal primary lesions. Shearwave assisted B- mode ultrasound
suggested a solid mass in a complex cyst in the kidney in one patient and in the other there
were multiple benign cysts and a solid mass however the third patient with liver mass found to
have primary from gall bladder. These findings were later confirmed on histopathology or cytology.
CONCLUSION: Shearwave elastography is an emerging non invasive technology showing
potential role to supplement B-mode ultrasound in detecting unknown primary cancerin breast
and abdomino-pelvic region.
Key words: Unknown Primary Cancer, Shearwave Elastography, cancer imaging.