目的: 探究三维剪切波弹性成像（3D-SWE）联合超声乳腺影像报告与数据系统（BI-RADS-US）分级定性对乳腺结节的诊断价值。方法: 选择2020年1月―2022年3月期间本院收治的120例乳腺结节女性患者,其病灶良恶性均经病理学结果证实,所有受试对象均行常规超声（US）,使用BI-RADS-US分类标准判断乳腺结节良恶性,并行3D-SWE检查,测量良恶性结节不同平面结节最硬处测量弹性最大值（Emax）、周围脂肪组织处比值（Eratio）。以病理检查结果为金标准,分析对比以上两种方法对乳腺结节的诊断效能。结果: 病理学结果显示,120例乳腺结节患者,总共发现120个病灶,其中良性结节为92个,恶性结节为28个;BI-RADS-US分级定性结果显示,良性结节85个,恶性结节35个;恶性结节不同平面的Emax、Eratio均高于良性结节;ROC曲线分析结果显示,BI-RADS-US分类诊断乳腺结节良恶性病变的敏感度、特异度分别为93.00%、87.00%;3D-SWE中,矢状面Eratio诊断乳腺结节良恶性病变的曲线下面积最大（0.884）,其对应临界值为3.39 kPa,敏感度、特异度分别为86.00%、89.00%;3D-SWE矢状面Eratio联合BI-RADS-US分类诊断曲线下面积为0.960,敏感度、特异度分别为96.00%、96.00%,两者联合诊断乳腺结节良恶性病变的曲线下面积、敏感度、特异度均高于单一检测。结论: 3D-SWE联合BI-RADS-US分级定性可提高对乳腺结节的诊断价值,减少良性结节不必要的手术或活检,避免过度治疗。

Objective To investigate the value of three-dimensional shear wave elastography (3D-SWE) combined with ultrasonographic subcategorization of Breast Imaging Reporting and Data System (BI-RDS-US) in qualitative diagnosis of breast nodules. Methods A total of 120 female patients with breast nodules who were admitted to the hospital from January 2020 to March 2022 were selected. The properties of their lesions were confirmed by pathology, and all subjects underwent conventional ultrasound (US) examination. The Bi-MADS-US classification standard was used to judge benign and malignant nodules.3D-SWE was performed to measure the maximum elasticity (Emax) of the hardest part of the nodule and the elasticity ratio of surrounding adipose tissues (Eratio) on different planes of benign and malignant nodules. With pathological results as the golden standard, diagnostic efficacy of the two methods for breast nodules was comparatively analyzed. Results Pathological results showed that there were a total of 120 lesions in 120 patients with breast nodules, including 92 benign nodules and 28 malignant nodules. The results of BI-RADS-US classification showed that there were 85 benign nodules and 35 malignant nodules. Emax and Eratio on different planes of malignant nodules were higher than those of benign nodules. ROC curve analysis results showed that the sensitivity and specificity of BI-MADS-US classification for diagnosing benign and malignant breast nodules were 93.00% and 87.00%, respectively. The area under the curve (AUC) of sagittal Eratio in 3D-SWE for diagnosing benign and malignant breast nodules was the largest (0.884), and the corresponding cut-off value was 3.39 kPa. The sensitivity and specificity were 86.00% and 89.00%. The AUC, sensitivity and specificity of sagittal Eratio combined with BI-RDS-US classification were 0.960, 96.00% and 96.00%, which were higher than those of single diagnosis. Conclusion 3D-SWE combined with BI-RDS-US classification can improve the diagnosis of breast nodules, reduce unnecessary surgery or needle biopsy, and avoid overtreatment.