Learning objectivesTo determinate the diagnostic performance of sonographic elastography for the differentiation of benign from malignant breast masses.BackgroundMATERIAL AND METHODS:Sonographic elasticity images of 86 nonpalpable breast masses (30 benign and 56 malignant masses). After subtraction of B-mode images from color elasticity images. Elasticity images were also reviewed and were assigned a score on a five-point scale. Lesion dimensions were measured by using calipers on recorded B-mode US images and elastography postacquisition images. Two quantitative elasticity values were extracted, the first corresponding to the elasticity value of the lesion and the second to the elasticity value of normal tissue. Distinguishing benign from malignant: Promising data, “Reassurance”, Pitfalls.RESULTS:Quantitative elasticity values in normal breast tissue clearly delineated the different structures. Elastography has emerged as a promising technique for improving lesion differentiation. The cancers were statistically significantly darker than fibroadenomas (P < 0.005) and substantially larger on the elastogram than on the sonogram. Seventy-three percent of fibroadenomas and 56% of solid benign lesions could be distinguished from cancers by using lesion brightness and size difference. For cancers, the average size estimates on the elastograms were generally larger than measurements obtamed from the freshly removed surgical specimens.ConclusionElastography has the potential to be useful in the evaluation of areas of shadowing on the sonogram. It also may be helpful in the distinction of benign from nonpalpable malignant masses.