<![CDATA[Breast ultrasound is commonly used to evaluate breast lesions, but distinguishing benign from malignant masses remains challenging, particularly in BI-RADS category 3 and 4 lesions. Shear wave elastography measures tissue stiffness and may improve diagnostic accuracy. One important feature is the stiff rim sign, which indicates increased stiffness around a lesion. This systematic review evaluated the diagnostic role of the stiff rim sign in breast lesions. A literature search was conducted for studies assessing shear wave elastography in ultrasound-detected breast lesions. Six studies met the inclusion criteria. The results consistently showed that the stiff rim sign had moderate to high accuracy in differentiating malignant from benign lesions. Peri-lesional stiffness was strongly associated with malignant pathology and improved diagnostic performance when combined with conventional ultrasound. Overall, the stiff rim sign may help improve risk assessment and support biopsy decision-making in BI-RADS 3 and 4 breast lesions. Keywords: stiff rim sign; shear wave elastography; breast lesion; BI-RADS; breast cancer diagnosis; biopsy.]]>
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