Diagnostic Value of Ultrasound Elastography Combined with BI-RADS in the Risk Stratification of Breast Masses

Background: The incorporation of elastography into standard ultrasound assessments increases the confidence of radiologist in opting for short-term monitoring instead of unnecessary biopsies for questionable breast lesions. Aim: This study aimed to assess the diagnostic performance of ultrasound BI-RADS combined with elastography parameters [elastography score (ES) and strain ratio (SR)] for differentiating benign from malignant breast lesions. Patients and methods: A retrospective review was conducted on 137 solid breast lesions classified as BI-RADS 3 or 4 on ultrasound. Histopathology served as the reference standard. Diagnostic indices including accuracy, sensitivity, specificity, positive and negative predictive values, and the area under the ROC curve (AUC) were calculated for BI-RADS alone and in combination with elastography measures. Results: Of the examined lesions, 77 were benign and 60 were malignant. Patients with malignant tumors were significantly older (p < 0.001). Malignant masses demonstrated higher ES and SR values and were more frequently assigned to higher BI-RADS categories (p < 0.001). Adding elastography to BI-RADS improved sensitivity from 89.9% to 100%, though specificity declined slightly from 92% to 89%. Compared to pairing BI-RADS with ES, the combination of BI-RADS with SR produced higher sensitivity (95% vs. 90%) but lower specificity (86% vs. 92%). Both combined approaches yielded higher PPV than BI-RADS alone (90% and 92% vs. 89%). Using SR cutoff of 2.45 produced 89.9% sensitivity and 69.2% specificity, while ES cutoff of 3.5 yielded 45.8% sensitivity and 80% specificity. Conclusion: Combining BI-RADS with ES or SR substantially enhanced the detection of malignant breast lesions. This integrated approach improved diagnostic confidence and helped limit unnecessary biopsies by refining risk stratification.