Shear Wave Elastography for Characterization of Breast Lesions in Clinical Routine

OBJECTIVES: Breast cancer remains a major global health challenge, and conventional B-mode ultrasound frequently encounters limitations in reliably distinguishing benign from malignant lesions, particularly within intermediate Breast Imaging-Reporting and Data System (BI-RADS) categories. These uncertainties often contribute to unnecessary biopsies. Shear wave elastography (SWE), a quantitative method for assessing tissue stiffness, may improve diagnostic confidence by providing objective elasticity thresholds. This study aimed to evaluate the diagnostic accuracy of SWE in routine clinical practice and to determine optimal stiffness cut-off values for differentiating benign from malignant breast lesions. METHODS: In this prospective single-center study, 73 women (mean age 48.6 ± 15.6 years) with BI-RADS 3-5 breast lesions underwent SWE examination prior to biopsy. Stiffness measurements (kPa and m/s) were obtained for each lesion. Histopathology served as the reference standard. Diagnostic performance was assessed, and optimal thresholds were determined using receiver-operating characteristic (ROC) analysis. Intra- and interobserver reproducibility were evaluated. RESULTS: Malignant lesions demonstrated significantly higher stiffness values (mean 56.7 kPa) compared with benign lesions (mean 18.7 kPa). SWE exhibited excellent diagnostic accuracy with an AUC of 0.932. The optimal cut-off value for distinguishing malignant from benign lesions was 40.03 kPa (sensitivity 88%, specificity 95%), corresponding to 3.6 m/s. Stiffness measurements showed high reproducibility across observers. CONCLUSION: SWE accurately differentiates benign from malignant breast lesions, improving specificity, and potentially reducing unnecessary biopsies. Standardization is needed to support widespread clinical adoption.