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Breast Ultrasound Elastography and BI-RADS

Strain and shear-wave elastography: lesion stiffness assessment for breast cancer characterization

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Radyoloji department. Book Appointment →

What is Breast Ultrasound Elastography and BI-RADS?

Breast elastography exploits the principle that malignant tissue is stiffer than benign tissue. Two main techniques: strain elastography (qualitative, manual compression with patient breathing or transducer pressure, color-coded display, Tsukuba 5-point scale) and shear-wave elastography (SWE - quantitative, push pulse generates shear waves, measured in kPa or m/s, operator-independent).

Strain interpretation: Tsukuba 1-3 likely benign (uniform soft, mosaic), 4-5 likely malignant (stiff lesion + surrounding tissue, BGR sign). Length ratio (lesion strain length/B-mode size) >1.0 suggests malignancy. SWE cutoffs: <30 kPa benign, 30-50 kPa indeterminate, >50-80 kPa highly suspicious for malignancy (variable thresholds).

BI-RADS integration: ACR BI-RADS 5th edition recommends elastography as adjunct to B-mode US; can downgrade BI-RADS 4a (low suspicion) lesions if soft on elastography to BI-RADS 3 (probably benign), avoiding biopsy. Cannot upgrade lesions. Sensitivity 88-95%, specificity 78-90% combined with B-mode. Pitfalls: superficial/deep lesions, pre-compression artifact, calcifications, post-biopsy changes.

Symptoms

(Elastography is an imaging technique, not a disease)
Performed for evaluation of:
Palpable breast lump (clinical exam)
Imaging-detected breast lesion (BI-RADS 3-4)
Dense breast tissue (mammography limitations)
Ambiguous mammographic finding
Surveillance of high-risk patients
Treatment response assessment for chemotherapy
Post-biopsy or post-surgery follow-up

Risk Factors

Indications for breast elastography:
BI-RADS 3 or 4a lesion (avoid unnecessary biopsy)
Dense breast (ACR Type C or D)
Family history of breast cancer (high-risk surveillance)
Post-biopsy follow-up
Pre-treatment baseline for chemotherapy response
Pregnant or lactating women (avoid radiation)
Limitations: very superficial/deep lesions, large lesions exceeding ROI, calcifications

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Palpable breast lump requiring evaluation
  • BI-RADS 3 or 4a lesion on screening mammogram/US
  • Indeterminate finding requiring further characterization
  • Family history of breast cancer with screening
  • Pre- or post-treatment evaluation of breast cancer
  • Dense breast tissue with mammographic limitations
  • Post-biopsy area of concern
  • Pregnant patient with palpable lump (radiation-free imaging)

Treatment Methods

01
(Elastography is diagnostic — not therapeutic)
02
Standard B-mode ultrasound first (BI-RADS classification)
03
Strain elastography: light transducer pressure, normal breathing
04
Color overlay interpretation (red soft, blue stiff)
05
Tsukuba 5-point scoring
06
Length ratio measurement (E/B ratio)
07
Shear-wave elastography: ROI placement, kPa or m/s measurement
08
Cutoff: <30 kPa benign, >50-80 kPa suspicious
09
BI-RADS adjustment based on elastography (downgrade only)
10
Repeat measurements (3-5 ROIs) for reproducibility
11
Document quality (uniform color in pre-compression image, no motion artifact)
12
Combine with Doppler (vascular pattern), microcalcification (mammography)
13
Tissue diagnosis (biopsy) remains gold standard for suspicious lesions
14
Reporting: BI-RADS category, elastography findings, recommendation
15
Follow-up imaging or biopsy based on combined assessment

Which Department to Visit?

You can visit our Radyoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Radyoloji Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.