With the expanded role of screening breast ultrasonography and accumulating clinical experience, the American College of Radiology (ACR) has established the Breast Imaging Reporting and Data System (BI-RADS) ultrasonography lexicon to standardize terminology for description and management recommendations according to stratified risks.

It has been established that probably benign (BI-RADS category 3) lesions having a malignancy rate of less than 2% require short-term imaging follow-up rather than immediate biopsy. The BI-RADS 4 category is assigned to suspicious lesions for which biopsy is recommended.

Routine screening methods such as mammography and breast ultrasound are valuable methods for managing breast masses.   Breast ultrasound is the preferable screening method as it provides high sensitivity for detecting breast cancer in women with dense breast tissue and can detect cancers not identified on mammography in asymptomatic women with dense breast tissue.

In our study we included 46 patients with different breast lesions. All patients had a conventional B-mode ultrasound examination and were evaluated according to the BIRADS categories, then real time free-hand ultrasound elastography was performed in the same session and images were       evaluated using both the Tsukuba elasticity score and the strain ratio method. Finally, the results were compared to the histopathologic results of those lesions. It was found that conventional B-mode ultrasound examination had a sensitivity of 72.73% and specificity of 83% While, elastography scoring alone turned out to have sensitivity of 65.5%, specificity of 83.4% using the Tsukuba score system. The additional of Strain ratio parameter for evaluating the elastography images showed the highest sensitivity 98.4% and specificity 85.68% at a best cutoff point of 3.47.

So we have found that elastography is an easy procedure with high diagnostic performance which can be easily integrated with the B-mode ultrasound examination in the same session and improves its specificity. That has proven benefit in minimizing the number of unnecessary biopsies especially in the  assessment of BIRADS 3 and 4 lesions.