European Radiology

, Volume 27, Issue 6, pp 2282–2291 | Cite as

Comparison of strain and shear-wave ultrasounic elastography in predicting the pathological response to neoadjuvant chemotherapy in breast cancers

  • Yan Ma
  • Shuo Zhang
  • Jing Li
  • Jianyi Li
  • Ye Kang
  • Weidong Ren



To compare the diagnostic performances of strain elastography (SE) and shear-wave elastography (SWE) for predicting response to neoadjuvant chemotherapy (NACT) in patients with breast cancer.


This prospective study recruited 71 eligible patients from June 2014 to May 2016. All patients provided written informed consent. Tumour stiffness was assessed by the SE strain ratio (R), SWE maximum elasticity (Emax) and SWE mean elasticity (Emean). Ultrasonic elastography (UE) assessments were performed at each NACT cycle (t1 − t6). For the purpose of predicting, the relative changes in elastographic parameters after the first and second NACT cycles were considered as the variables [Δ(t1) and Δ(t2)]. The area under the receiver operating characteristics (AUC) curve was compared.


ΔEmean(t2) and R2 displayed the best diagnostic performances within their own modalities (AUC = 0.93 and 0.90 for predicting favourable response to NACT; AUC = 0.92 and 0.78 for predicting NACT resistance, respectively). There were no significant differences in AUCs for ΔEmean(t2) and some UE parameters (P > 0.05). By contrast, ΔEmean(t2) was significantly superior to all other SE parameters for predicting resistance (P < 0.05).


SE and SWE exhibited similar performances for predicting favourable NACT responses; SWE was better than SE for predicting NACT resistance.

Key Points

Elastography parameters after the second NACT cycle showed the best diagnostic performances.

SWE and SE yielded similar diagnostic performances in predicting favourable responses.

SWE performed better than SE in predicting the pathological resistance to NACT.

Discrepant results may be due to the breast thickness and lesion depth.


Shear-wave elastography Strain elastography Neoadjuvant chemotherapy Breast cancer Predict 



Area under the ROC


Maximum elasticity


Mean elasticity


Neoadjuvant chemotherapy


Pathological complete response


Residual cancer burden


Receiver operating characteristics


Region of interest


Strain ratio


Strain elastography


Shear-wave elastography


Ultrasounic elastography



The scientific guarantor of this publication is Weidong Ren. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by Fundamental Research Funds of Shengjing Hospital, China Medical University (MD63) and Science and Technology Project Funds from Education Department of Liaoning Province(LK201621). Qijun Wu, Chao Ji and Liqiang Zheng kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

Supplementary material

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Yan Ma
    • 1
  • Shuo Zhang
    • 2
  • Jing Li
    • 1
  • Jianyi Li
    • 3
  • Ye Kang
    • 4
  • Weidong Ren
    • 1
  1. 1.Department of UltrasoundShengjing Hospital of China Medical UniversityShenyangChina
  2. 2.Department of NeurologyShengjing Hospital of China Medical UniversityShenyangChina
  3. 3.Department of Breast SurgeryShengjing Hospital of China Medical UniversityShenyangChina
  4. 4.Department of PathologyShengjing Hospital of China Medical UniversityShenyangChina

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