The goal of our study was to investigate the value of color-coded Virtual Touch tissue imaging (VTI) using acoustic radiation force impulse (ARFI) technology in the characterization of breast lesions and to compare it with conventional ultrasound (US). Conventional US and color-coded VTI were performed in 196 solid breast lesions in 196 consecutive women (age range 17-91 y; mean 48.17 ± 14.46 y). A four-point scale VTI score was assigned for each lesion according to the color pattern both in the lesion and in the surrounding breast tissue. The mean VTI score was significantly higher for malignant lesions (3.80 ± 0.66, range 1-4) than for benign ones (2.02 ± 1.20, range 1-4) (p < 0.001), and the optimal cut-off value was between score 3 and score 4. The area under the receiver operating characteristic (ROC) curve for combined conventional US and VTI (0.945) was significantly higher than that for conventional US (0.902) and for VTI (0.871) (p = 0.0021 and p < 0.001, respectively). It was concluded that color-coded VTI with the proposed four-point scale score system combined with conventional US might have the potential to aid in the characterization of benign and malignant breast lesions.