## 4 Discussion  
This study provides evidence that elastography added to the B-mode in the evaluation of subcentimeter nodules implies an increase in the number of patients who are correctly diagnosed (96.92%). This is shown by the elastography of patients with a cyst artifact, which obtained a high probability that it would be a cyst and that further follow-up or an invasive diagnostic test would not be needed, whereas on the other hand, lesions with stiff patterns would increase the diagnostic suspicion, which would demand a histopathological diagnosis (75% of successes). Many authors [13; 14; 15; 16] have shown the usefulness of the \begin{table}
\begin{tabular}{c c c} \hline \hline
**Histopathological Diagnosis** & **N (65)** & **\%** \\ \hline Cyst & 15 & 23.1\% \\ Fatty lobule & 6 & 9.2\% \\ Epithelial lesions & 41 & 61.5\% \\ Malignant lesions & 3 & 6.2\% \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Histopathological findings of the 65 lesions. \begin{table}
\begin{tabular}{c c c c} \hline \hline  & \multicolumn{2}{c}{**Histopathological Result**} & **Total** \\ \cline{2-4}  & **Malignant** & **Benign** & \\ \hline \multirow{2}{*}{**Elastography patterns**} & Stiff (pattern 4) & 3 & 1 & 4 \\  & Soft (patterns 1, 2, and 3) and cyst artifact & 1 & 60 & 61 \\ \hline
**Total** & & 4 & 61 & 65 \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Histological correlation with the elastography patterns of the lesions evaluated in the study. combination of ultrasonography and elastography for the differentiation of benign and malignant lesions, which should increase the diagnostic precision and could contribute to the improvement of the BI-RADS classification. However, there is a scarce number of studies that have analyzed small-sized lesions in an isolated manner, and these tend to be focused on quantitative elastography SWE [13; 14; 15; 17]. In this sense, it should be pointed out that the literature shows the efficiency of different elastography techniques for the differential diagnosis of solid bodies in breasts by considering their size [10]. However, other authors [9; 10; 11] have reported on the contribution of SWE to the diagnosis of breast cancer in lesions <2 cm. Our study also supports the usefulness of elastography for the early detection of malignant lesions \(\leq\)1 cm, and up to the present, it is the only study in the literature in which lesions that are so small in size have been analyzed. In addition to semiquantitative elastography (SWE), the significant association between the diagnosis based on the elastography pattern and the histopathological diagnosis of all the benign solid nodules \(\leq\)1 cm (\(p<0.05\)) is evident in our results. These findings are in agreement with those reported in the literature, which have shown the contribution of the association between ultrasonography and elastography for the differentiation between benign and malignant lesions [13; 18]. With respect to the cyst artifact, an association was demonstrated between it and the histopathological diagnosis of the cystic lesions (\(p<0.02\)), with a high specificity (94%). These findings are in agreement with those obtained by [PERSON] [19]. Keeping in mind that cystic nodules <1 cm are benign lesions, it can be assumed that the detection of this artifact would be diagnostic, and therefore unnecessary punctures would not be needed. Elastography is defined as a decisive test for the diagnosis of benign or malignant sub-centimeter nodules, with a correct diagnosis in a high number of cases (96.92%). Therefore, when faced with B-mode images categorized as having a low suspicion of malignancy and elastograms with a cyst artifact, we could category them as BI-RADS 2; if the elastograms were soft (patterns 1, 2, or 3), we could say that we are dealing with lesions with a high probability of being benign (BI-RADS 3), whereas lesions with more stiff elastograms (patterns 4 or 5) would necessarily have to be biopsied (BI-RADS 4a or b), as already proposed by other authors [20].