To assess the value of real-time shear wave elastography (SWE) in the differential diagnosis of benign and malignant lesions of the breast.

Sixty-one female patients (63 lesions) who underwent breast surgery at the First Affiliated Hospital of Zhejiang University were included. Elastic modulus was measured by SWE before surgery. Using pathological diagnosis as the golden standard, the receiver operating characteristic (ROC) curves of quantitative parameters of real-time SWE were plotted to assess their clinical value in distinguishing benign and malignant breast lesions.

Pathology revealed 38 benign cases (40 lesions) and 23 malignant cases (23 lesions). Maximum elasticity (Emax) of malignant lesions was significantly higher than that of benign lesions [(82.26 ± 41.37) kPa vs (20.97 ± 7.31) kPa, P<0.01]. Mean lesion-to-gland elasticity ratio (Eratio) for benign lesions was significantly lower than that for malignant lesions (1.588±0.543 vs 5.260±2.190, P<0.01). Using 55.8 kPa as a threshold for Emax, the area under the ROC curve (AUC) was 0.963, with a sensitivity of 0.913, specificity of 0.950, and accuracy of 0.937. Using 3.45 as a threshold for Eratio, the AUC was 0.948, with a sensitivity of 0.913, specificity of 0.925, and accuracy of 0.921.

Quantitative elastic modulus can improve the differential diagnosis between benign and malignant breast lesions.