Testicular SWE: Tumor Stiffness vs. Benign Lesion
The Role of SWE in Characterizing Testicular Lesions
According to the EFSUMB guidelines on multiparametric ultrasound of the scrotum (Bertolotto et al., 2026), elastography cannot be used as an independent method for characterizing testicular lesions. However, when integrated into multiparametric ultrasound (MPUS), it enhances the accuracy of lesion characterization.
Tumor Stiffness vs. Benign Lesion
Generally, testicular neoplasms exhibit greater tissue stiffness than non-tumor lesions; this is observed in both shear wave elastography (SWE) and strain elastography (SE). Most malignant tumors show increased stiffness on elastography, whereas the proportion of benign tumors with increased stiffness is significantly lower.
Advantages of SWE over Strain Elastography
SWE is less operator-dependent than strain elastography and allows for both qualitative and quantitative assessment (according to Griffith, Diagnostic Ultrasound: Musculoskeletal, 2025). However, elastography remains an auxiliary method and does not have sufficient specificity for independently distinguishing between benign and malignant lesions.
Methodological Limitations
Threshold stiffness values for the testicle are not provided in the source fragments [to be clarified]. It should be noted that for the thyroid gland, for example, there is no single consensus on stiffness ranges for differentiating benign and malignant nodules, and threshold values differ between devices from different manufacturers (EFSUMB, Cantisani et al., 2026). Similarly, quantitative SWE values for the testicle may also depend on the equipment.
| Characteristic | Tumor (often malignant) | Benign Lesion |
|---|---|---|
| Stiffness by SWE/SE | Increased in most | Increased significantly less often |
| Role of Elastography | Only as part of MPUS, not as an independent method | |
Frequently asked questions
Can testicular SWE be used as an independent method?
No. According to EFSUMB (Bertolotto et al., 2026), elastography is not used as an independent method for characterizing testicular lesions but enhances diagnostics as part of MPUS.
Is a testicular tumor stiffer than a benign lesion?
Generally, yes. Testicular neoplasms usually exhibit greater stiffness than non-tumor lesions, according to both SWE and strain elastography data.
Are all benign formations soft?
No. Increased stiffness is characteristic of most malignant tumors, but the proportion of benign tumors with increased stiffness is significantly lower—not zero.
How is SWE better than strain elastography?
SWE is less operator-dependent and allows for both qualitative and quantitative assessment (Griffith, 2025).
What threshold stiffness values should be used for the testicle?
Specific thresholds are not indicated in the provided fragments [to be clarified]; quantitative SWE values may vary between devices from different manufacturers.