The present study aimed at evaluating and comparing the diagnostic performance of B-mode ultrasound (US),elastography score (ES), and strain ratio (SR) for the differentiation of breast lesions. This retrospective studyenrolled 431 lesions from 417 in-hospital patients. All patients were examined with both conventional ultrasoundand elastography. Two experienced radiologists reviewed ultrasound and elasticity images. The histopathologicresult obtained from ultrasound-guided core biopsy or operation excisions were used as the reference standard.Pathologic examination revealed 276 malignant lesions (64%) and 155 benign lesions (36%). A cut-off pointof 4.15 (area under the curve, 0.891) allowed significant differentiation of malignant and benign lesions. ROC(receiver-operating characteristic) curves showed a higher value for combination of B-mode ultrasound andelastography for the diagnosis of breast lesions. Conventional ultrasound combined elastography showed highsensitivity, specificity, and accuracy for group II lesions (10mm<lesion diameter ≤20mm). Elastography combinedwith conventional ultrasound show high specificity and accuracy for differentiation of benign and malignantbreast lesions. Elastography is particularly important for the diagnosis of BI-RADS 4 and small breast lesions.