Objective To compare the diagnostic efficacy of strain elastography (SE), shear wave elastography (SWE), and pulsed Doppler ultrasound (PDU) for breast lesions, and explore whether there is a correlation between lesion hardness and blood flow.

Methods Eighty-five 85 patients with breast cancer were detected by routine ultrasound, PDU, SE and SWE before the operation. All patients were treated with surgery within one week after examination. Taking the postoperative pathological results as the gold standard, the elasticity score (Score), fat to mass strain ratio (FLR) and gland to mass strain ratio (GLR) were statistically analyzed. The correlations among the maximum Young's modulus (Emax), mean Young's modulus (Emean), minimum Young's modulus (Emin), standard deviation of Young's modulus (Esd), peak systolic velocity (PSV), end-diastolic velocity (EDV), pulsar index (PI) and resistance index (RI) of the mass were analyzed.

Results Except for Emin and EDV, the values of remaining elastic parameters of patients with malignant breast lesions were all higher than those of patients with benign lesions (P ＜ 0.01). The diagnostic efficacy of Esd and PI was the best, with AUCs of 0.881 and 0.877 respectively, but there was no statistical significance between Esd and PI (P ＞ 0.05). In SWE, the Emax was moderately positively correlated with PI and RI (P ＜ 0.01), and the Emean was also moderately positively correlated with PI and RI (P ＜ 0.01). In SE, the FLR was low positive correlation with PI (P ＜ 0.01), and moderate positive correlation with RI (P ＜ 0.01). In the benign group, there was no significant correlation between various elastic parameters and blood flow parameters (P ＞ 0.05). In the malignant group, the Emax, FLR and RI all showed a low positive correlation (P ＜ 0.05).

Conclusions The diagnostic efficacy of different elastography and pulsed Doppler ultrasound for benign and malignant breast lesions is similar. There is a certain correlation between the elastic parameters and blood flow parameters of breast lesions. Especially in malignant lesions, there may be a connection between the hardness characteristics and blood flow features of breast lesions.