Aims and objectives 1. To assess the efficacy of Elastography in evaluation and differentiation of benign from malignant breast lesions. 2. To correlate the accuracy of ultrasound elastography for differential diagnosis of breast lesions with FNAC / Histopathological analysis as a reference standard. Materials and methods: A prospective cross sectional observational study was conducted on patients with breast lesions, referred from the Department of Surgery, both inpatient and outpatient. They underwent ultrasound examinations at the Department of Radiodiagnosis from August 2022 to April 2024, focusing on ultrasound and elastography, after obtaining informed consent. Data obtained was subjected to app statistical analysis. Results: Our study evaluated multiple imaging techniques for diagnosing breast lesions. B-mode ultrasonography using the BIRADS scoring system achieved 97.83% sensitivity, 88.89% specificity, and 93% accuracy. Elastoscan with a Tsukuba score (≥4.0 cutoff) showed 95.65% sensitivity, 90.74% specificity, and 93% accuracy. E-strain elastography (ratio >2.80 cut-off) demonstrated 94.0% sensitivity, 86.0% specificity, and 90.0% accuracy. Shear wave elastography (>92.80 kPa cut-off) yielded 95.65% sensitivity, 90.74% specificity, and 93% accuracy. All methods had an area under the curve exceeding 0.947 and a significant p-value of 0.001, indicating their robust performance in distinguishing between benign and malignant breast lesions. Conclusion: Elastography demonstrates excellent diagnostic performance for distinguishing between benign and malignant breast masses.