Background: Transvaginal sonographic elastography is a useful technique for the differentiation of benign and malignant lesions in different part of body. In recent researches on strain elastography it has been concluded that different endometrial parts showed different stiffness features. Our goal in this study is to assess the diagnostic utility of transvaginal sonographic elastography in differentiating benign masses from endometrial cancer. Method: Patients undergoing routine pelvic ultrasonography examinations and suspected intracavitary uterine focal lesions with abnormal uterine bleeding were the subjects of this prospective study. Two types of sonography were performed on the 200 patients: elastography and traditional B-mode sonography. For qualitative analysis, endometrial lesions were divided into three categories, and for quantitative analysis, the strain ratio (SR) was calculated. Additional pathological exams were carried out in order to get a final diagnosis. Result: There were 103 patients diagnosed with benign lesions and 103 patients with endometrial cancer. While 94.6% of type 3 endometrial lesions were found to be malignant, all type 1 lesions were found to be benign. The AUC for SR was 0.903 with 95% CI between 0.867 and 0.943 for quantitative elastography results. The optimal cut-off SR value, as determined by ROC curve analysis, was 3.03, achieving 82.5% sensitivity, 84.6% specificity, 82.8% positive predictive value, 84.3% negative predictive value and accuracy 83.6%. These findings suggested that SR has good diagnostic performance and that transvaginal sonographic elastography is a useful diagnostic tool for separating benign masses from endometrial cancer. Conclusion: We have concluded that transvaginal sonographic elastography is a potentially useful method for identifying benign and malignant endometrial lesions in addition to standard sonography. [ABSTRACT FROM AUTHOR]