Abstract Objective To analyze the application of elasticity score and strain ratio (SR) in the diagnosis of triple negative breast cancer (TNBC) and their relationship with microvessel density (MVD). Methods A total of 150 patients with breast cancer admitted to the hospital from January 2021 to December 2023 were reviewed. They were divided into TNBC group (29 cases) and non-TNBC group (121 cases) according to the surgical and pathological results. Baseline data, UE elasticity score, SR, and MVD were compared between the two groups. The receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of UE elasticity score and SR in TNBC. Pearson method was used to analyze the relationship between UE elasticity score, SR and MVD in patients with TNBC. Results UE elasticity score and SR of the TNBC group [(4.35±0.18) and (3.57±0.28)] were higher than those of the non-TNBC group [(4.19±0.13) and (3.36±0.15)] (P<0.05). ROC curves indicated that the AUC values of UE elasticity score and SR for diagnosing TNBC were 0.791 and 0.734. The AUC of combination of the two for diagnosing TNBC was 0.877 (95% CI: 0.814-0.925). The sensitivity and specificity were 75.86% and 86.78%. The AUC of combined diagnosis was higher than that of diagnosis using a single indicator (Z=5.372, 3.885, P=<0.001, <0.001). MVD of the TNBC group [(46.75±11.23)/mm2] was high than that of the non-TNBC group [(39.28±10.05)/mm2] (P<0.05). Pearson analysis results showed that UE elasticity score and SR were positively correlated with MVD in patients with TNBC. Conclusion UE elasticity score and SR can be used for diagnosing TNBC. Combined diagnosis with the two is beneficial for improving diagnostic accuracy. In addition, there is a significant correlation between UE elasticity score, SR and MVD.