Ultrasound Strain Elastography in Diagnosis of Breast Lesions

Objectives

To determine the diagnostic performance of ultrasound strain elastography for differentiating benign and malignant breast lesions, using histopathology as the reference standard. METHODOLOGY This prospective diagnostic-accuracy study was conducted in the Department of Radiology, Bacha Khan Medical College and Mardan Medical Complex, Mardan, from January to March 2026. Ninety-seven patients with suspected breast lesions were enrolled by non-probability consecutive sampling. Conventional ultrasonography followed by strain elastography was performed in all patients. BI-RADS category, elasticity score, and strain ratio (cut-off 3.5) were compared with histopathology. Data were analyzed using IBM SPSS Statistics version 25.

Results

Strain elastography showed a sensitivity of 94.9%, specificity of 86.2%, positive predictive value of 82.2%, negative predictive value of 96.2%, and overall accuracy of 89.7%. Elastography findings were strongly associated with histopathological diagnosis (p < 0.001). BI-RADS category, elasticity score, and strain ratio also showed strong to very strong correlations with histopathology.

Conclusion

Ultrasound strain elastography demonstrated high diagnostic performance in differentiating benign from malignant breast lesions. Used as an adjunct to conventional ultrasonography and BI-RADS assessment, it may improve diagnostic confidence and help reduce unnecessary biopsy.