What Is an Elastogram?

What to expect when undergoing this test

 

An elastogram is a type of medical imaging test that maps stiffness and elasticity (stretchiness, springiness, flexibility) of soft tissues. This information tells doctors a lot about the health of tissues and can help in diagnosing breast cancer. Elastography combines the latest in ultrasonic imaging technology with the oldest form of breast cancer detection: touch.

elastography process
 Verywell / JR Bee

Purpose of Test

Back in 1980, about four out of five women with breast cancer found a lump on their own through self-examination. While that practice is still important, most breast cancers today are discovered via mammogram, ultrasound, or magnetic resonance imaging (MRI). These tests are good at detecting masses, but they show benign (non-cancerous) lumps as well as malignant (cancerous) ones.

Then and now, the only accepted way to find out for sure whether a lump is cancerous is to do a breast biopsy. About 80% of breast biopsies come back negative for cancer, meaning they were only done to rule out a breast cancer diagnosis.

The surgery involved with biopsies is costly and involves its own risks. So, for many years, the medical community has worked to figure out a non-invasive diagnostic test that could both detect suspicious areas and determine whether or not they're cancerous.

An elastogram could be that test.

How It Works

During a breast exam, a healthy breast is "elastic," meaning that it's pliable and soft. When there's a tumor over a certain size, though, you can feel a hard, inflexible lump, almost like a rock or a peach pit. Cancerous tumors have very low elasticity, meaning they don't change shape readily when you press on them, while benign tumors tend to be flexible. It's this property that enables elastography to work.

In several studies, elastography has been able to detect when a tumor would be benign on biopsy around 90% of the time. A few false positives and negatives (when a tumor looks cancerous but isn't, or vice versa) have been reported. There's some concern that "soft" breast cancers, such as mucinous carcinoma, would cause false negatives, and "hard" benign breast tumors, such as fibrous adenomas, would cause false positives, so more studies will likely look into this.

Overall, studies appear very promising, with a review of the literature concluding that use of elastography may help guide the process of distinguishing benign and malignant breast lumps in the future.

Risks and Contraindications

Ultrasound elastography doesn't carry risks and is generally considered safe for anyone, including pregnant women. Unlike some scans, it doesn't rely on radiation, contrast materials, or anything else that could pose a concern.

That said, the U.S. Food and Drug Administration (FDA) urges ultrasound to only be used when medically necessary, especially during pregnancy.

Before the Test

Typically, you won't need to do anything to prepare for your elastogram. If any special preparations are necessary, your doctor or a staff member from the facility where the test is being done will let you know.

Timing

You should expect the exam to take up to about half an hour, or longer if both breasts are examined. Be sure to arrive early enough to get checked in and change your clothes.

Location

Elastography can be performed anywhere that has an ultrasound machine, such as a hospitals, clinics, medical labs, imaging facilities, and some doctor's offices.

What to Wear

You'll need to remove your clothing from the waist up and put on a medical gown that opens in the front so your breast(s) can be accessed. A top that's easy to get in and out of is best.

Since you'll be lying down, you might want to avoid shorter skirts. Also, wear bottoms that are unlikely to stain if ultrasound gel gets on them.

Food and Drink

You should be able to eat and drink normally before and after the test.

Cost and Health Insurance

The cost of elastography varies depending on where you have it done. If you have insurance, check with your carrier to see if your policy covers the test and any facility fees, as well as whether you'll have to pay a portion of the cost. You may need pre-authorization.

What to Bring

Have your insurance card and any written orders your doctor may have given you when you arrived for your elastogram.

During the Test

The elastogram will be performed by a radiologist or sonographer.

Pre-Test

Once it's time for you elastogram, you'll change into a provided gown and go to a private room where you will be asked to lie down on an examination table. The technician performing the test will ask you to expose the breast to be scanned and will apply gel to the area.

Throughout the Test

The technician will then place a device called a transducer on the area be assessed and move it around while it sends images to a monitor off to the side.

The first part of the exam will be like a standard breast ultrasound. Normal breast tissue has small features that show up in ultrasound images, and these features work as position markers for what comes next. If there are any lumps, these will show up too, but so far, the ultrasound image does not tell the doctor anything more than there are suspicious lumps, which mammograms do as well.

Then, just enough pressure is applied to the breast to move it slightly. (This pressure is probably much less than is used during a mammogram.) The system takes another ultrasound image and a computer program compares the two and produces a map showing how elastic the different regions are. This is the elastogram.

Ultrasounds are typically painless, but if your breasts are tender, it may be uncomfortable. Let the person examining you know if you feel any discomfort.

Post-Test

Once the test is over, you'll be given a towel or tissues so you can wipe off the gel and get dressed. You may be asked to wait while a radiologist goes over the images, just to make sure they got everything they needed. Don't expect to be told the results right away.

You shouldn't have any side effects to manage and can resume normal activity right away.

Interpreting Results

The radiologist will study the images and get the results to your doctor. Your doctor should pass these along to you, if you didn't receive them directly as well, and let you know what, if any, follow-up is necessary.

It's a good idea to ask when you should expect to hear back about your results so you can call if you haven't heard anything in the anticipated timeframe.

Follow-Up

Depending on the results, your doctor may want you to come in for an appointment or schedule another test or procedure.

A Word From Verywell

Any procedure that could reveal breast cancer can be scary. It can be hard not to imagine the worst-case scenario. Try to keep in mind that about eight out of 10 of women with lumps in their breast do not have cancer.

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