European Journal of Cardiovascular Medicine

Background and Objectives: Breast lesions are a common diagnostic challenge. While B-mode ultrasound is widely used for initial evaluation, ultrasound elastography (UE) has emerged as a complementary technique to differentiate benign from malignant lesions based on tissue stiffness. This study aims to assess the diagnostic utility of strain and shear wave elastography in characterizing focal breast lesions. Materials and Methods: This prospective observational study included 100 female patients with palpable or imaging-detected breast lesions referred for sonographic evaluation. Each underwent B-mode ultrasound followed by elastography. Lesions were categorized using BI-RADS and elastography scoring systems. Histopathology or FNAC was used as the reference standard. Diagnostic parameters including sensitivity, specificity, PPV, NPV, and accuracy were calculated. Results: Of the 100 lesions evaluated, 68 were benign and 32 were malignant on histopathology. Elastography showed significantly higher stiffness values in malignant lesions (mean elasticity score: 4.3 ± 0.5) compared to benign ones (2.1 ± 0.6, p < 0.001). The sensitivity and specificity of elastography were 91% and 85%, respectively, with a diagnostic accuracy of 88%. A cut-off strain ratio of >3.0 yielded the best discriminatory value. Ultrasound elastography changed management decisions in 27% of cases. Conclusions: Ultrasound elastography is a valuable adjunct to conventional B-mode imaging in differentiating benign from malignant breast lesions. It enhances diagnostic confidence and may reduce unnecessary biopsies when interpreted alongside clinical and sonographic findings