Abstract: Objective To explore the diagnostic value of multi-modal ultrasound in Breast Imaging Reporting and Data System(BI-RADS)category 4 breast lesions. Methods A total of 70 BI-RADS category 4 lesions in 63 patients who underwent needle biopsy or resection of breast lesions were selected, including 40 benign lesions(benign group)and 30 malignant lesions(malignant group). The general clinical features, preoperative ultrasound diagnosis, and postoperative pathologic results were reviewed. Results There were no significant differences in nodule shape, orientation, internal echogenicity, margin, boundary, posterior echo attenuation and calcification between benign and malignant breast lesions(P>0.05). However, significant differences were observed in hyperechoic halos and Adler flow grades(P<0.05). The maximum value of shear wave velocity(SWVmax), elasticity imaging/B-mode ratio(EI/B), and strain ratio(SR)were higher in the malignant group than in the benign group, with significant differences(P<0.05). The area under the receiver operating characteristic curve(AUC)for SWVmax was 0.94, and the optimal cutoff value, diagnostic sensitivity and specificity were 2.85 m/s, 86.7% and 95.0%, respectively. The AUC for EI/B was 0.92, and the optimal cutoff value, and diagnostic sensitivity and specificity were 1.01, 96.7% and 82.5%, respectively. The AUC for SR was 0.78, and the optimal cutoff value, diagnostic sensitivity and specificity were 7.86, 76.7% and 72.5%, respectively. Multivariate binary Logistic analysis showed that the OR of SWVmax and EI/B of the malignant group were 12.97(P<0.05)and 1.51(P<0.05), respectively. Conclusion Reasonable application of multi-modal ultrasound is able to effectively identify benign and malignant BI-RADS category 4 breast lesions and reduce unnecessary needle biopsies.

Key words: Breast, Ultrasound, Shear wave elastography, Strain elastography