Background: Ultrasound scanning is noninvasive, usually painless procedure that used as the main adjuvant modality with mammography for depiction of the breast lesions nature. It is easy-to-use and less expensive than other imaging modalities. Besides lacking the exposure risk to ionizing radiation as in mammography, it also provides real-time imaging, and can easily detect lesions in women with dense breasts. Conventional ultrasound however is not free from limitation. It cannot replace annual mammography and careful clinical breast examination. Being an operator dependent, US needs experienced radiologists as well as good equipment to avoid misinterpretation of the lesions, and to decrease the number of false positive and false negative results. Aim of the Work: is to detect the impact of ultrasound elastography in diagnosis of solid breast lesions, and to evaluate its capability in differentiating benign form malignant lesions, with special focus on: A-Evaluation of sensitivity and specificity of sonoelastography, with cyto-histological diagnosis taken as the reference. B-Detection of the ability of sonoelastography to provide additional information on tissue elasticity in the event of equivocal mammographic and/or sonographic findings in order to guide the diagnostic workup towards biopsy or follow-up. Patients and methods: The present study is a prospective research work that included 39 patients with breast lesions where elastographic ultrasound was performed following screening or diagnostic mammography and breast ultrasound to evaluate its possible impact on accurate diagnosis and consequent guidance for management planning. This study was performed at a private center in the period from September 2017 to March 2018. The patients' age ranged between (24 - 72 years) with a mean of 48 years. Results: The elastography scores for different breast lesions was:Lesions that scored 1, 2, and 3 were considered benign(30/39 cases, 77 %), whereas lesions that scored 4 and 5 (9/39 cases, 23%) were considered malignant. After revising pathology results of the 30 cases diagnosed as benign by elastography scoring 26/30(87%) were benign (true negative) by pathology and 4/30(13%) were malignant by pathology (false negative).After revising pathology results of the 9 cases diagnosed as malignant by elastography scoring 7/9(82.8%) lesions confirmed to be malignant by pathology (true positive) and 2/9(17.2%) lesions were proved to be benign by pathology (false positive).The calculated sensitivity of elastography score was 80%, specificity was 88.9%, PPV and NPV were 82.8% and 87% respectively, and the total accuracy was 85.3%.Conclusion: Sonoelastography is a simple, non-invasive diagnostic technique that provides information about the stiffness of a breast masses, thus completing the morphological assessment of B-mode ultrasound. Recommendations: Other studies are recommended to be performed on axillary lymph nodes, to evaluate the elastographic efficacy in differentiating between reactive and malignant pathologically enlarged axillary lymphadenopathy.