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Diagnostic performance of 2D-shear wave elastography in the diagnosis of breast cancer: a clinical appraisal of cutoff values

  • Breast Radiology
  • Published:
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To assess the role of 2D-shear wave elastography (2D-SWE) in differentiating benign from malignant focal breast lesions (FBLs), providing new vendor-specific cutoff values.


158 FBLs (size: 3.5–50 mm) detected in 151 women (age: 21–87 years) were prospectively evaluated by means 2D-SWE. For each lesion, an expert radiologist assessed US BI-RADS category and calculated the following four 2D-SWE parameters: (1) elasticity maximum (Emax); (2) mean elasticity (Emean); (3) minimum elasticity (Emin); (4) elasticity ratio (Eratio). US-guided core-biopsy was considered as standard of reference for all the FBLs classified as BI-RADS 4 or 5. For each 2D-SWE parameter, the optimal cutoff value for a diagnostic test was calculated using the Youden method. Diagnostic performance of the US BI-RADS and 2D-SWE parameters was calculated accordingly.


83/158 (52.5%) FBLs were benign and 75/158 (47.5%) were malignant. Statistically significant higher stiffness values were observed in malignant FBLs for all 2D-SWE parameters than in benign ones (p < 0.001). 2D-SWE cutoff values were 82.6 kPa, 66.0 kPa and 53.6 kPa, respectively, for Emax, Emean, Emin and 330.8% for Eratio. The 2D-SWE parameter showing the best diagnostic accuracy was Emax (85.44%). Considering US BI-RADS 3 (n = 60) and 4a (n = 32) FBLs, Emax and Emean showed the best diagnostic accuracy (85.87% for both), without a statistically significant decrease in sensitivity (p = 0.7003 and p = 1, respectively).


Our study provides new vendor-specific cutoff values for 2D-SWE, suggesting its possible clinical use in the adjunctive assessment of category US-BI-RADS 3 and 4a breast masses.

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Authors and Affiliations



TVB, AAMO and DM contributed to the study conception and design. Material preparation, data collection and analysis were performed by TVB, AAMO, MD, AC, CZ, FF and SV. The first draft of the manuscript was written by TVB, AAMO and DM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.”

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Correspondence to Alessia Angela Maria Orlando.

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Conflict of interest

Tommaso Vincenzo Bartolotta is lecturer and scientific advisor for Samsung. Other authors declare that they have no conflict of interest. This research was supported by research equipment from SAMSUNG MEDISON Co., Ltd.

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Institutional ethical committee approval was obtained, and full written informed consent was obtained for this prospective study. Our study complied with the terms of the Declaration of Helsinki.

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Bartolotta, T.V., Orlando, A.A.M., Dimarco, M. et al. Diagnostic performance of 2D-shear wave elastography in the diagnosis of breast cancer: a clinical appraisal of cutoff values. Radiol med 127, 1209–1220 (2022).

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