超声弹性成像联合常规超声在诊断BI-RADS 3~4类乳腺肿物良恶性中的临床价值分析

Clinical Value of Ultrasound Elastography Combined with Conventional Ultrasound in Differentiating Benign and Malignant Breast Masses Classified as BI-RADS 3~4

摘要: 目的：探讨剪切波弹性成像和应变式弹性成像技术联合常规超声对BI-RADS 3~4级乳腺肿物良恶性的诊断价值。方法：回顾性分析合肥市第二人民医院2024年8月至2025年8月的患有乳腺肿物的63例患者的临床病理资料，术前接受常规超声检查、应变式弹性成像和剪切波弹性成像检查。以病理结果为金标准将病灶分为良性组(39例)和恶性组(24例)，比较两组弹性应变率比值(SR)、剪切波平均弹性模量值(Emean)，绘制ROC曲线评估BI-RADS分类、SR值及Emean值联合诊断乳腺肿物良恶性的效能。结果：63例乳腺肿物中，BI-RADS分类结果显示，3类18例，4a类18例，4b类20例，4c类7例，将4b类及以上诊断为恶性，BI-RADS分类诊断恶性乳腺肿物的灵敏度为83.3%，特异度为79.5%。恶性组Emean及SR值均显著高于良性组(P < 0.05)。BI-RADS、Emean、SR单独诊断的AUC (Area under the ROC Curve, ROC曲线下的面积)分别为0.814、0.772、0.757。将三者联合后，AUC提高至0.927 (95% CI 0.864~0.990)，灵敏度91.7%，特异度89.7%，诊断效能优于任一单指标及其他两两联合指标。结论：对于BI-RADS 3~4类乳腺肿物，BI-RADS + Emean + SR联合指标具有良好的诊断效能，可进一步提高乳腺肿物良恶性诊断的准确性，为临床无创、精准评估乳腺肿物性质提供可靠依据。

Abstract: Objective: To evaluate the diagnostic performance of shear-wave elastography (SWE) and strain elastography (SE) combined with conventional ultrasound for distinguishing benign from malignant breast masses classified as BI-RADS 3~4. Methods: A prospective study was conducted on 63 consecutive female patients who presented with breast masses at Hefei Second People’s Hospital between August 2024 and August 2025. All patients underwent conventional ultrasound, SE, and SWE before surgery or biopsy. Pathology served as the reference standard, resulting in 39 benign and 24 malignant lesions. Elastic strain ratio (SR) and mean shear-wave elastic modulus (Emean) were compared between groups. ROC curves were constructed to assess the diagnostic efficacy of BI-RADS category, SR, and Emean alone and in combination. Results: Among the 63 lesions, BI-RADS distribution was 18 category 3, 18 category 4a, 20 category 4b, and 7 category 4c. Using BI-RADS ≥ 4b as the cutoff, the sensitivity and specificity were 83.3% and 79.5%, respectively. Malignant lesions exhibited significantly higher Emean and SR values than benign lesions (P < 0.05). AUCs for BI-RADS, Emean, and SR alone were 0.814, 0.772, and 0.757, respectively. Combining the three parameters increased the AUC to 0.927 (95% CI 0.864~0.990), with sensitivity 91.7% and specificity 89.7%, outperforming any single or pairwise combination. Conclusions: For BI-RADS 3~4 breast masses, the combined use of BI-RADS, Emean, and SR substantially improves diagnostic accuracy, offering a reliable non-invasive tool for precise characterization of breast lesions.