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The shear deformation under loads contains useful information for distinguishing benign breast lesions from malignant ones. In this study, we proposed a normalized shear deformation indicator (NSDI) that was derived from the concept of principal strains. Since the NSDI requires both high-quality axial and lateral (parallel and perpendicular to the beam, resp.) displacement estimates, a strategy combining high-quality speckle tracking with signal “denoising” was employed. Both techniques were previously published by our group. Finite element (FE) models were used to identify possible causes for elevated NSDI values in and around breast lesions, followed by an analysis of ultrasound data acquired from 26 biopsy-confirmed  in vivo  breast lesions. We found that, theoretically, the elevated NSDI values could be attributed to two factors: significantly hardened tissue stiffness and increasing heterogeneity. The analysis of  in vivo  data showed that the proposed NSDI values were higher ( p  < 0.05) among malignant cancers as compared to those measured from benign ones. In conclusion, our preliminary results demonstrated that the calculation of NSDI value is feasible and NSDI could add value to breast lesion differentiation with current clinical equipment as a postprocessing tool.

A Normalized Shear Deformation Indicator for Ultrasound Strain Elastography in Breast Tissues: An In Vivo Feasibility Study