Does ultrasound shear wave elastography (SWE) improve the diagnostic accuracy of the diagnosis of musculoskeletal soft tissue tumours (MSK STTs) when compared with B-mode ultrasounds in adult patients?

Abstract

Abstract: Background & Rationale: Soft tissue tumours (STTs) are diverse, benign, and malignant. Some tumours are anticipated to be reactive, while others are unquestionably neoplastic. Less than 4% and 7-10% of all tumours are individually MSK STTs in both adults and children. The refinement of non-invasive imaging to more Accurately differentiate between benign and malignant lesions is necessary to minimise not only the necessity of a biopsy but also to minimise related costs and complications. Therefore, elastography has been developed as a novel ultrasound (US) method that can help to more accurately differentiate between MSK STTs, bringing in the fuller assessment of tissue stiffness and elasticity. This warrants an investigation as to whether the nature of MSK STTs in adult individuals can be determined more accurately via SWE than via a B-mode ultrasound. The study aim is to examine the diagnostic accuracy of SWE in diagnosing MSK STTs compared with B-mode US imaging, against the standard reference measure among adult patients. Additionally, this SLR intended to examine the research quality of existing evidence about SWE and B-mode US’s accuracy in diagnosing MSK STTs. Methods: The structure literature review (SLR) was conducted using a PICO framework-based literature search of a range of electronic databases to develop the research question. The papers were found using a search strategy and a range of academic/electronic databases and screened using pre-determined inclusion and exclusion criteria. These sources were evaluated in terms of their research quality and risk of bias based on a QUADAS-2 checklist, and the accuracy of the SWE and the B-mode US findings was assessed based on the sensitivity and specificity rates. Results: The rates of specificity were similar between 72% and 91% for SWE and between 78.8% and 98% for B-mode US between studies against the reference measure. For sensitivity, SWE rates appeared higher than B-mode US, 66.7% and 93% for SWE and between 42% and 82% for the B-mode US. The main limitations of these studies were the use of different SWE techniques and indices as well as the varied subtypes of STTs. Conclusions & Implications: Further investigations are vital to assess the accuracy of SWE in the diagnosis of MSK STTs in adult patients. The SLR findings are not considered precise enough to serve as evidence for the accuracy of the SWE. Future examinations should include a uniform method of the SWE and the lesion type. These recommendations will increase the reliability of future findings.