Elastography-Based Modeling of Breast Non-Mass Lesions: Comparative Diagnostic Performance of Qualitative and Quantitative Metrics.

This study assessed the diagnostic efficiency of strain elastography in differentiating benign and malignant non-mass breast lesions (NMLs) detected on ultrasonography. A total of 149 patients (mean age, 48.8±10.6 y) with histopathologically confirmed NMLs were retrospectively analyzed. Each lesion was evaluated using B-mode ultrasonography and strain elastography, and both elasticity score and strain ratio were recorded. The mean strain ratio was significantly higher in malignant lesions than in benign ones (3.2±0.96 vs. 1.8±0.9, P<0.001). Receiver operating characteristic curve analysis showed a high diagnostic accuracy for strain ratio (area under the curve=0.863; 95% CI: 0.794-0.931), with a cutoff value of 2.45 yielding 82.8% sensitivity and 77.5% specificity. Lesions with an elasticity score ≥4 were more likely to be malignant (P<0.001). In multivariable modeling, adding elastography parameters to conventional ultrasonography improved diagnostic performance, and decision curve analysis demonstrated superior net clinical benefit for elastography-based models compared with ultrasonography alone. These findings suggest that integrating strain elastography into routine ultrasonographic assessment can enhance diagnostic accuracy and support clinical decision-making in patients with NMLs.