Breast elastography is a new non-invasive imaging technique used to evaluate the elasticity, or stiffness of breast tissue in addition to conventional breast imaging modalities such as ultrasound (USS) and mammography [1]. The study aimed to assess the clinical value of real-time ultrasound elastography in differentiating malignant from benign breast tumors and To estimate the performance of ultrasound elastography in BIRADS classification of breast lesions. Subjects and Methods: A prospective study was performed in Benghazi Radiology Center El-Hawari and included 80 patients. The USS results of conventional and real-time elastography and histopathology were collected. The data analyzed by and calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value NPV, and diagnosis accuracy of B-mode ultrasound and elastography were determined. The informed consent was collected from each participatant. The study carried out on 80 patients of different age groups. The mean age of the studies cases was 45.9 ± 16.99 years. The current study revealed that the prevalence of malignant breast lesion was high in married women (71%) in older age group > 60 years , while, benign breast lesion represented 83% in single women in younger age group (20-40 years). According to histopathological classification of our study cases, malignant breast masses was (29%) invasive ductal carcinoma. The investigator reported higher differences in results of sensitivity (96.8%), specificity (97.9%), diagnosis accuracy (97.5%), PPV (96.8%,) and NPP (97.9%) while, that of B-mode ultrasound (93.7%,91.6%,92.5%,88.2%,91.6% respectively). Conclusion: elastography is an accurate complementary approach to conventional breast imaging modalities Recommendations: Further research is needed to fully establish elastography's role in clinical practice and optimize its patient benefits.................... Keywords: .................Breast elastography, BIRADS, positive predictive value (PPV), negative predictive value NPV), diagnosis accuracy.