探讨三维能量多普勒超声（3D-PDS）联合超声乳腺影像报告与数据系统（BI-RADS）在乳腺良、恶性病灶鉴别诊断中的应用价值。

2013年12月至2015年7月于哈尔滨医科大学附属第二医院接受乳腺肿瘤手术的患者257例，共282个病灶，于术前行二维超声及3D-PDS检查，根据病理学诊断结果，分成良性组与恶性组。比较2组病灶二维超声特征及3D-PDS特征是否存在差异。以病理结果为金标准，绘制受试者操作特性（ROC）曲线，比较2种方法单独应用以及联合应用对乳腺病灶鉴别诊断的能力。

282个乳腺病灶中，良性病灶175个（62.1%），恶性病灶107个（37.9%）。2组病灶二维超声特征比较，病灶形状、生长方位、边界、边缘、后方回声、钙化差异均有统计学意义（P值均<0.01）；3D-PDS血管特征比较，血管分布、形态、有无穿入血管差异均具有统计学意义（P值均<0.05）。3D-PDS与超声BI-RADS联合应用诊断乳腺病灶ROC曲线下面积为0.866，大于单独应用超声BI-RADS及3D-PDS（0.820、0.727）。

超声BI-RADS与3D-PDS联合应用可提高乳腺良、恶性病灶的鉴别诊断效能。

To explore the capacity of three-dimensional power doppler sonography (3D-PDS) ultrasound combined with breast imaging reporting and data system (BI-RADS) for ultrasonography in the differential diagnosis of benign and malignant breast lesions.

The BI-RADS and 3D-PDS were conducted on 257 patients with 282 lesions prior to operation. The conventional ultrasound features and three dimensional vascular features were compared between the malignant lesions and benign ones with histopathological results as the reference standard. The clinical values of BI-RADS alone, 3D-PDS alone and the combination of two methods were obtained by the receiver operating characteristic (ROC) curve.

In total of 282 breast tumors, there were 175 (62.1%) benign lesions and 107 (37.9%) malignant ones. Statistical significant differences were observed in tumor shape, orientation, boundary, margin, posterior acoustic feature and calcification between the two groups in terms of two dimensional sonography features (P<0.01), and the vascular distribution, the morphology of the vessels and the perforator vessel in the 3D vascular features (P<0.01). The area under the curve (AUC) of the combined method was greater than that of BI-RADS and 3D-PDS.

There were significant differences in conventional ultrasound features, as well as in three-dimensional vascular characteristics between the malignant breast lesions and the benign ones. BI-RADS and 3D-PDS both have limitations., However, BI-RADS combined with 3D-PDS can improve the diagnostic efficiency.