The role of combined ultrasonic BI-RADS and ultrasound elastography in discriminating between benign and malignant breast nodules

This research is designed to examine how well the combination of ultrasonic breast imaging-reporting and data system (BI-RADS) classification and ultrasound elastography (UE) works in discriminating between benign and malignant breast nodules (BNs). It also seeks to confirm the clinical applicability of this combined approach in diagnostically challenging cases involving dense breast tissue and small BNs. We retrospectively reviewed 280 patients with BNs (142 assessed by BI-RADS alone, and 138 evaluated with the combined approach) between March 2023 and February 2025. Using pathological biopsy as the gold standard, the diagnostic performance – including sensitivity, specificity, accuracy, and Kappa value – of the 2 groups was compared. Additional subgroup assessments focused on dense breast tissues (American College of Radiology categories C/D) and small nodules (≤5mm). The sensitivity, specificity and accuracy of BI-RADS combined with UE in the diagnosis of malignant BN were 91.30%, 86.96% and 89.86%, respectively (Kappa = 0.886), which was better than that of BI-RADS alone. In addition, the diagnostic sensitivity of BI-RADS combined with UE for dense nodules and small nodules was also higher than that of BI-RADS alone ( P <.05). The combined use of ultrasonic BI-RADS and UE enhances diagnostic accuracy by concurrently evaluating morphological features and tissue stiffness, offering improved differentiation between benign and malignant BNs.