In this part of the JABTS BC-04 study, we evaluated the utilities of combining B-mode (B), color Doppler (CD) and strain elastography (E) of the breast. Pathology-confirmed breast masses were registered from 16 institutions in Japan. Findings of B, CD, and, if available E, as well as clinical data, were collected. The images obtained were then evaluated by a Centralized Image Interpretation Committee. In total, 674 solid masses, all of which had been examined using B, CD and E, were analyzed (malignant: 415, benign: 259). Mean ages of patients with malignant and benign masses were 58.6 ±12.5 (mean ± SD) and 44.3 ± 12.5, respectively. Sensitivity and specificity for the Elasticity Score (ES) were 91.3% and 71.4% (ES 1,2 vs 3,4,5). Sensitivity and specificity for B alone, the combination of B and CD (B+CD) and the combination of B, CD and E (B+CD+E) were 98.8%/42.1%, 99.0%/39.0%, and 98.6%/52.9%, respectively. The specificity of B+CD+E was significantly improved relative to the sensitivity of B alone (p=0.014). In premenopausal patients, if vascularity was 3+ or an incident angle near 0° was observed, the B-mode category was increased by one. In patients younger than 40 years of age with oval or lobulated masses, if there was no penetrating flow and vascularity was 0-2+, the B-mode category was reduced by one. We call this a modified evaluation method for CD results. When this was applied, the specificity of B+CD was estimated to improve significantly from 39.0% to 52.1% (p=0.013). Furthermore, using this modified CD evaluation method, the estimated specificity of B+CD+E was 63.3%. Specificities of benign/malignant diagnosis improved significantly with elastography. Furthermore, specificity is anticipated to improve further with modification of the CD evaluation method in premenopausal women.