Int J Med Sci 2021; 18(15):3615-3623. doi:10.7150/ijms.64243 This issue

Research Paper

Role of “Stiff Rim” sign obtained by shear wave elastography in diagnosis and guiding therapy of breast cancer

Yan-jun Xu1#, Hui-ling Gong2#, Bin Hu2✉, Bing Hu1✉

1. Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai 200233, P.R, China
2. Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai 201199, P.R, China
# Yan-jun Xu and Hui-ling Gong contributed equally to the manuscript.

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Xu Yj, Gong Hl, Hu B, Hu B. Role of “Stiff Rim” sign obtained by shear wave elastography in diagnosis and guiding therapy of breast cancer. Int J Med Sci 2021; 18(15):3615-3623. doi:10.7150/ijms.64243. Available from

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Graphic abstract

Background: Because the halo around the tumor in shear wave elastography (SWE) is defined as the “stiff rim” sign, the diagnosis of breast lesions with the stiff rim sign is popular. However, only a few studies have described the stiff rim sign quantitatively.

Objective: This study aimed to investigate the usefulness of the stiff rim sign in the diagnosis and tumor, node, metastasis stage of breast cancer.

Methods: Two hundred and ten breast lesions were analyzed retrospectively. The maximum, mean, minimum Young's modulus (YM), and the YM standard deviation in the lesion, the peritumoral stiffness (shell), and the region containing lesion and shell were obtained. The suspicious SWE feature with the best diagnostic performance was chosen to downgrade or upgrade the Breast Imaging Reporting and Data System (BI-RADS) classification. The coincidence rates of SWE and B-mode ultrasound in T staging and their positive predictive value (PPV) for T staging were compared.

Results: The presence of “stiff rim” sign was selected to upgrade or downgrade the BI-RADS classification because of its best performance. In pathological benign lesions, 18.9% (25 of 132) of lesions should undergo biopsy if BI-RADS combined with the stiff rim sign were referred while it was 57.6% (76 of 132) if BI-RADS alone was referred. The coincidence rate of T2 staging evaluated by SWE was significantly higher than B-mode ultrasound (about 30% increase, P < 0.001). The PPVs of SWE for T1 and T2 staging were higher than B-mode ultrasound (P < 0.05).

Conclusions: BI-RADS combined with “stiff rim” sign is expected to improve the diagnostic performance of breast lesions to avoid unnecessary biopsy. The maximum diameter of the lesion measured in SWE is more accurate than B-mode ultrasound in the estimation of T staging, which is beneficial to the treatment and prognosis of breast cancer.

Keywords: stiff rim sign, shear wave elastography, breast lesion, BI-RADS, TNM stage