الفهرس 
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Abstract
As palpation of the breast has been well established to be a very important clinical examination for assessing breast lesions , studies have been performed in order to reach an imaging technique that provides the same information as palpation together with avoiding pitfalls of the clinical palpatory method.
Elastography is a new ultrasound technique based on the idea of palpation which states that malignant tissues are harder than benign ones. Thus by measuring tissue stiffness we can estimate the probability of malignancy.
Elastography is performed in the same session of ultrasound taking about five minutes more than the conventional ultrasound examination. By means of light compression with the probe the image will be displayed either by the lesion size comparison method or the colour coding method.
Recently colour coded images is the most applicable method where images are displayed on the screen ,superimposed on the normal B-mode ultrasound image. This is performed through an integrated software in the conventional ultrasound machine. The colour code will range from red for the softest tissues to blue for the most hard. Usually the lesion gives a mixture of the different colours which by using a scoring system could be given a degree of stiffness and thus determine the probability of malignancy.
The idea of the scoring system is based on the relative ratio between soft and hard areas within the lesion. If all of the lesion is soft , it is given a score of 1. If all the lesion is hard together with the surrounding area it is given a score of 5.
Elastography has been performed as a complementary examination to the conventional US examination assessed by the BIRADs scoring system and not as a separate examination.
As regards the performance of Elastography it is still debatable. Many studies have been performed to determine whether it is of benefit to add Elastography examination to the conventional ultrasound examination. Most of the studies showed that Elastography has lower sensitivity but higher specificity than conventional ultrasound. However there was great variability in the outcome depending on the cut-off point used when measuring the results.
Although many of the studies could not prove actual measure benefit of performing Elastography yet they found it to be an easy procedure which can be easily integrated with the normal US examination and they recommended further studies with larger number of lesions to be performed in order to reach more accurate results.
However it is worth knowing that the value of Elastography in assessment of BIRADs 3 and 4a lesions specifically have proven benefit in minimizing the number of unnecessary biopsies when these lesions give low Elastography scores especially if the score is 1.
Studies have been performed to semiquantify the Elastography assessment. The strain ratio have been integrated in order to have a more quantitative value for tissue stiffness and it proved better results than the 1-5 score if used alone.
Elastography is a new and easy procedure which needs further research studies to get the utmost of its benefits.