High-Grade DCIS in Fibroadenoma Missed by Shape-Based AI Ultrasound but Caught by Elastography

A benign-appearing breast mass was classified as BI-RADS 2 by an AI ultrasound tool based on shape. However, shear-wave elastography showed markedly elevated stiffness (max 135.48 kPa), leading to biopsy that revealed high-grade DCIS arising in a fibroadenoma. Malignancy can ret…

• Integrated AI lesion assessment returned BI-RADS 2 based on oval, parallel, circumscribed shape and orientation; elastography contradicted with maximum elasticity of 135.48 kPa.
• Biopsy confirmed high-grade (nuclear grade 3) DCIS confined to the fibroadenoma, with clear margins and no nodal involvement (pTisN0).
• This single case underscores that quantitative elastography should not be disregarded when discordant with shape-based classification, human or algorithmic.

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