Objective To compare the diagnostic performances of shear-wave elastography(SWE) and contrast-enhanced ultrasonography(CEUS) in differentiating the BI-RADS 4 breast lesions. Methods 70 patients with 72 lesions were examined with SWE and CEUS respectively. Maximum elasticity (E_max) and CEUS 5-point scores were assessed. The results were compared using the area under the receiver operating characteristic curve (AUC). To combine with BI-RADS, the accuracy of E_max and CEUS 5-point scores were compared. Results The AUC of E_max and CEUS 5-point scores were 0.840、0.754. No significant difference was noted. The accuracy of E_max(93.9%) was higher than that of CEUS 5-point scores(75.7%)in 4A lesions(P<0.05). There were no significant differences in accuracy among other categories. Conclusions Both SWE and CEUS were helpful for the differentiation the BI-RADS 4 breast lesions , and the diagnostic performance of SWE and CEUS was similar.