Skip to main content
Log in

Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript


Shear wave elastography (SWE) is an emerging technique which can obtain quantitative elasticity values in breast disease. We therefore evaluated the diagnostic performance of SWE for the differentiation of breast masses compared with conventional ultrasound (US). Conventional US and SWE were performed by three experienced radiologists for 158 consecutive women who had been scheduled for US-guided core biopsy or surgical excision in 182 breast masses (89 malignancies and 93 benign; mean size, 1.76 cm). For each lesion, quantitative elasticity was measured in terms of the Young’s modulus (in kilopascals, kPa) with SWE, and BI-RADS final categories were assessed with conventional US. The mean elasticity values were significantly higher in malignant masses (153.3 kPa ± 58.1) than in benign masses (46.1 kPa ± 42.9), (P < 0.0001). The average mean elasticity values of invasive ductal (157.5 ± 57.07) or invasive lobular (169.5 ± 61.06) carcinomas were higher than those of ductal carcinoma in situ (117.8 kPa ± 54.72). The average mean value was 49.58 ± 43.51 for fibroadenoma, 35.3 ± 31.2 for fibrocystic changes, 69.5 ± 63.2 for intraductal papilloma, and 149.5 ± 132.4 for adenosis or stromal fibrosis. The optimal cut-off value, yielding the maximal sum of sensitivity and specificity, was 80.17 kPa, and the sensitivity and specificity of SWE were 88.8% (79 of 89) and 84.9% (79 of 93). The area under the ROC curve (Az value) was 0.898 for conventional US, 0.932 for SWE, and 0.982 for combined data. In conclusion, there were significant differences in the elasticity values of benign and malignant masses as well as invasive and intraductal cancers with SWE. Our results suggest that SWE has the potential to aid in the differentiation of benign and malignant breast lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others


  1. Itoh A, Ueno E, Tohno E et al (2006) Breast disease: clinical application of US elastography for diagnosis. Radiology 239:341–350

    Article  PubMed  Google Scholar 

  2. Fleury EdFC, Fleury JC, Piato S, Roveda D Jr (2009) New elastographic classification of breast lesions during and after compression. Diagn Interv Radiol 15:96–103

    PubMed  Google Scholar 

  3. Burnside ES, Hall TJ et al (2007) Differentiating benign from malignant solid breast masses with US strain imaging. Radiology 245:401–410

    Article  PubMed  Google Scholar 

  4. Regner DM, Hesley GK, Hangiandreou NJ et al (2006) Breast lesions: evaluation with US strain imaging-clinical experience of multiple observers. Radiology 238:425–437

    Article  PubMed  Google Scholar 

  5. Athanasiou A, Tardivon A, Tanter M et al (2010) Breast lesions: quantitative elastography with supersonic shear imaging—preliminary results. Radiology 256:297–303

    Article  PubMed  Google Scholar 

  6. Bercoff J, Tanter M, Fink M (2004) Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control 51:396–409

    Article  PubMed  Google Scholar 

  7. Bercoff J, Tanter M, Muller M, Fink M (2004) The role of viscosity in the impulse diffraction field of elastic waves induced by the acoustic radiation force. IEEE Trans Ultrason Ferroelectr Freq Control 51:1523–1536

    Article  PubMed  Google Scholar 

  8. Bercoff J, Chaffai S, Tanter M et al (2003) In vivo breast tumor detection using transient elastography. Ultrasound Med Biol 29:1387–1396

    Article  PubMed  CAS  Google Scholar 

  9. Tanter M, Bercoff J, Athanasiou A et al (2008) Quantitative assessment of breast lesion viscoelasticity: initial clinical results using supersonic shear imaging. Ultrasound Med Biol 34:1373–1386

    Article  PubMed  Google Scholar 

  10. Mendelson EB, Baum JK, Berg WA, Merritt CRB, Rubin E (2003) Breast Imaging Reporting and Data System, BI-RADS: Ultrasound, 1st edn. American College of Radiology, Reston

    Google Scholar 

  11. Heinze G (2004) A SAS macro, S-PLUS library and R package to perform logistic regression without convergence problems. Technical Report 2/2004: Medical University of Vienna, Vienna

  12. Evans A, Whelehan P, Thomson K et al (2010) Quantitative shear wave ultrasound elastography: initial experience in solid breast masses. Breast Cancer Res 12:R104

    Article  PubMed  Google Scholar 

  13. Raza S, Odulate A, Ong EM, Chikarmane S, Harston CW (2010) Using real-time tissue elastography for breast lesion evaluation: our initial experience. J Ultrasound Med 29:551–563

    PubMed  Google Scholar 

  14. Scaperrotta G, Ferranti C, Costa C et al (2008) Role of sonoelastography in non-palpable breast lesions. Eur Radiol 18:2381–2389

    Article  PubMed  Google Scholar 

  15. Thomas A, Fischer T, Frey H et al (2006) Real-time elastography—an advanced method of ultrasound: first results in 108 patients with breast lesions. Ultrasound Obstet Gynecol 28:335–340

    Article  PubMed  CAS  Google Scholar 

  16. Cho N, Moon WK, Park JS, Cha JH, Jang M, Seong MH (2008) Nonpalpable breast masses: evaluation by US elastography. Korean J Radiol 9:111–118

    Article  PubMed  Google Scholar 

  17. Egorov V, Kearney T, Pollak SB et al (2009) Differentiation of benign and malignant breast lesions by mechanical imaging. Breast Cancer Res Treat 118:67–80

    Article  PubMed  Google Scholar 

  18. Chung SY, Moon WK, Choi JW, Cho N, Jang M, Kim KG (2010) Differentiation of benign from malignant nonpalpable breast masses: a comparison of computer-assisted quantification and visual assessment of lesion stiffness with the use of sonographic elastography. Acta Radiol 51:9–14

    Article  PubMed  Google Scholar 

  19. Chang JM, Moon WK, Cho N, Kim SJ (2011) Breast mass evaluation: factors influencing the quality of US elastography. Radiology 259:59–64

    Article  PubMed  Google Scholar 

Download references


This study was supported by a grant from the Innovative Research Institute for Cell Therapy (A062260) and by a grant from the National R&D Program for Cancer Control (A01185), Ministry of Health & Welfare, Republic of Korea. The authors appreciated the statistical advice from the Medical Research Collaborating Center at the Seoul National University Hospital and the Seoul National University College of Medicine.

Conflict of interest

Authors declare no conflict of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Woo Kyung Moon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, J.M., Moon, W.K., Cho, N. et al. Clinical application of shear wave elastography (SWE) in the diagnosis of benign and malignant breast diseases. Breast Cancer Res Treat 129, 89–97 (2011).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: