**4.2 Echo-guided punctures**

Echo-guided punctures are made easier in areas displaying maximum modification in elasticity. The centre of the tumour is not always the area with the highest density in cancerous cells (central necrosis) which are to be found in larger numbers at the periphery of the tumour (**Figure 6**).

Patients having a second reading echography after an MR showing subtle or difficult to interpret images have benefitted from a better biopsy carried out under echo-elastography (29% improvement of the sensitivity). Decrease in the number of false positives and 40–50% reduction of biopsies concerning benign lesions for which puncturing is not needed, thanks to an improvement in the sensitivity of mammary echography (**Figure 7**).

**Figure 6.** *SWE 2D with coronal section of a carcinoma.*
