Abstract Objective To detect the diagnostic efficiency of sono elastographic strain ratio in discriminating malignant from benign solid breast masses and compare it with the sono elastographic elasticity score method. Patients and methods This study included 120 histopathologically diagnosed solid breast masses from 120 females (mean age 38.2 years). Elastography score and strain ratio (SR) were performed for each mass. Receiver operating characteristic (ROC) curve was plotted for both methods. Results The benign lesions had significant lower SR (mean 2.12 ± 1.72) than that of malignant lesions (mean 6.91 ± 3.96). The AUC from ROC curve was 0.98 for elasticity score and 0.99 for SR. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the elasticity score in the diagnosis of solid breast masses were 100%, 88%, 83.3%, 100% and 92.5% respectively, and of the strain ratio were 93.3%, 97.3%, 95.5%, 96.1% and 95.8% respectively (when cutoff value 3.77 was used). There is no statistically significant difference found between both methods. Conclusion SR has high diagnostic performance in differentiating malignant from benign solid breast masses, however there is no statistically significant difference between SR and elasticity score.