Diagnostic performance and clinical utility of shear-wave elastography in musculoskeletal soft-tissue tumors: a systematic review.

BACKGROUND

Shear-wave elastography (SWE) is increasingly used to assess musculoskeletal soft-tissue masses, but its diagnostic performance relative to ultrasonography (US) and magnetic resonance imaging (MRI) remains uncertain.

OBJECTIVE

To evaluate the diagnostic accuracy, reproducibility, and clinical utility of SWE for differentiating benign and malignant soft-tissue tumors.

METHODS

Following PRISMA-DTA guidelines, PubMed/MEDLINE, Embase, Web of Science, Scopus, ProQuest Dissertations and Theses, and RSNA/WFUMB proceedings were searched through 22 September 2025. Eligible studies included patients with histologically verified extraosseous soft-tissue masses evaluated using quantitative SWE. Sensitivity, specificity, and area under the ROC curve (AUC) were extracted or reconstructed. Owing to marked methodological and threshold heterogeneity, a narrative synthesis was performed. Certainty of evidence was rated with GRADE-DTA.

RESULTS

Ten studies (n = 1,335 lesions; 22-41% malignant) met inclusion criteria following a search of six databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, ProQuest Dissertations and Theses, and RSNA/WFUMB proceedings) through 22 September 2025. SWE reproducibility was high where reported (intraclass correlation coefficient > 0.85 in four studies), but diagnostic performance varied widely (AUC range 0.57-0.87). In some studies, In selected studies, SWE was associated with potentially higher specificity in benign-appearing or superficial lesions (ΔAUC +0.07 vs US in one cohort), but it failed to distinguish lipomatous or deep lesions from malignancy. MRI remained superior in most direct comparisons (AUC 0.85-0.90). Threshold heterogeneity and poor cross-vendor reproducibility limited generalizability. Certainty of evidence was moderate for superficial lesions and low for deep or lipomatous tumors.

CONCLUSION

SWE demonstrates excellent reproducibility but inconsistent diagnostic utility across lesion types. It should be applied selectively primarily for superficial, non-fatty lesions as an adjunct to US rather than as a stand-alone diagnostic tool. Standardized acquisition protocols and vendor calibration are prerequisites for broader clinical adoption.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1172017, identifier CRD420251172017.