Objective To compare the value of hardness rating and area ratio method of ultrasound elastography in differential diagnosis of benign and malignant lesions. Methods ultrasound imaging data of 120 cases with breast lesions(130 breast)who were pathologically confirmed during the period from January 2011 to June 2013 were retrospectively analyzed, there were 62 malignant tumors,68 benign tumors, the sensitivity, specificity, accuracy of hardness rating and area ratio method of ultrasound elastography in differential diagnosis of benign and malignant lesions were assessed. Results (1)The ultrasound elastography of 52 cases with benign tumor were 0-2point,16 cases were 3-4point,10 cases with malignant tumors were 0-2point,52 cases were 3-4point,the difference between two groups were statistically significant(χ2=11.55,P<0.05);(2) The average area ratio of benign tumor was(1.09±0.37),malignant tumors was(2.28±1.68),the difference between two groups were statistically significant(t=6.22,P=0.01);(3)the sensitivity,specificity,accuracy of elastography hardness rating in diagnosis of malignant breast tumors were 83.87%,6.47%,80.00%,the area ratio method were 80.65%,75.00%,77.68%,joint inspection of two groups were 93.10%,93.55%,93.09%, joint inspection had obvious advantages,the difference was statistically significant(all P<0.05). Conclusion Hardness rating and area ratio method of ultrasound elastography in differential diagnosis of benign and malignant lesions had higher value and higher diagnostic accuracy of combined. Key words: Ultrasound Elastography; Area ratio method; Breast lumps; Differential diagnosis