Background: Breast cancer is the most frequent cancer among women. Early detection of breast cancer is critical for improving prognosis.

Objectives: The current study aims to establish the added value of ultrasound (US) elastography to the BI-RADS classification system in the categorization of ambiguous breast lesions following mammography as a first step.

Subjects and methods: This cross-sectional study was performed at the Radiology Department of Zagazig University. Cases were referred from the outpatient clinic of the general surgery department with suspected breast lesions. All study population subjected to full history taking (clinical presentation, age, family and past history), clinical examination, histopathological and imaging examination (Conventional B-mode breast US and breast elastography).

Results: Elasticity and velocity detected by shear wave elastography were significantly elevated among cancerous lesions compared to benign lesions (P =0.02, 0.01, respectively). There was a significant variance between the qualitative measurements between malignant and benign lesions (P =0.02). Combining conventional imaging with shear wave elastography (SWE) reported a sensitivity of 83.3% and specificity of 91.7% with an AUC of 0.94.

Conclusion: SWE is a simple method with great diagnostic accuracy that can be easily combined with a B-mode US examination in the same session, increasing its specificity. It demonstrated usefulness in reducing the frequency of needless biopsies.