探讨乳腺癌及其边缘带剪切波弹性成像（SWE）定量参数与定性指标在乳腺癌Ki-67表达分级评估中的应用价值。

选取2019年3月至2020年1月于苏州大学附属第一医院就诊并经病理证实的80例乳腺癌患者（82个病灶）。利用灰阶超声测量病灶最大径，应用SWE定性观察是否有硬环征，定量测量病灶内部及其边缘1 mm、2 mm周缘范围SWE弹性模量值。以免疫组化结果为金标准，应用ROC曲线分析比较各项定性及定量指标、SWE弹性模量值以及联合方法评估乳腺癌Ki-67表达分级的效能。

82个病灶中Ki-67低表达组33个，高表达组49个。灰阶超声测量最大径≥2 cm评估乳腺癌Ki-67表达分级的ROC曲线下面积（AUC）为0.741，敏感度和特异度分别为63.3%、84.8%。病灶SWE硬环征评估乳腺癌Ki-67表达分级的AUC为0.837，敏感度和特异度分别为79.6%、87.9%。高表达组病灶周缘2 mm区域弹性模量最大值（E2Smax）明显高于低表达组（P＜0.001），在SWE各定量参数中具有最高的AUC值，其AUC值为0.719，最佳截断值为95.86 kPa，其判定Ki-67表达分级的敏感度和特异度分别为69.4%、72.7%。硬环征联合最大径联合诊断的AUC为0.889，敏感度和特异度分别为91.8%、78.8%。E2Smax联合最大径判定Ki-67表达分级的AUC为0.808，敏感度和特异度分别为83.7%、69.7%。

乳腺癌及其边缘带灰阶超声及SWE定量参数和定性指标对评估Ki-67表达分级具有良好的应用价值，其中最大径、硬环征和E2Smax诊断效能较高，尤其硬环征与最大径联合的综合诊断效能最佳，可为早期判断病灶侵袭性和治疗后预后评估提供客观有效的依据。

To assess the application value of quantitative and qualitative parameters of shear wave elastography (SWE) in evaluting Ki-67 expression levels in breast cancer.

A total of 82 lesions in 80 patients diagnosed pathologically with breast cancer were collected from March 2019 to January 2020 at the First Affiliated Hospital of Soochow University. The maximum diameter and elastic modulus of breast lesions and the 1-mm and 2-mm marginal zones around the lesions were quantitatively measured by gray-scale ultrasound and SWE. The stiff rim sign was observed by SWE imaging. Using the immunohistochemical analysis after surgery or puncture biopsy as the gold standard, ROC curve analysis was performed to obtain the optimal qualitative and quantitative indicators to predict the level of Ki-67 expression in breast cancer and to assess the efficiency of the combination of the optimal quantitative parameters and qualitative indicator for Ki-67 index grading.

Among the 82 lesions, 33 had low Ki-67 expression and 49 had high expression. The area under the ROC curve (AUC) of the maximum diameter (≥2 cm) measured by gray-scale ultrasound was 0.741, with a sensitivity of 63.3% and specificity of 84.8%. The AUC of stiff rim sign was 0.837, and the sensitivity and specificity were 79.6% and 87.9%, respectively. The maximum value of elastic modulus in the 2-mm marginal zones around the lesions (E2Smax) in the high-expression group was significantly higher than that in the low-expression group (P＜0.001); it had the highest AUC value (0.719) among the SWE quantitative indexes (cut-off value, 95.86kPa; sensitivity, 69.4%; specificity, 72.7%). The AUC of the combination of the stiff rim sign and the maximum diameter was 0.889, with a sensitivity of 91.8% and specificity of 78.8%. The AUC of the combination of E2Smax and the maximum diameter was 0.808, with a sensitivity of 83.7% and specificity of 69.7%.

The quantitative parameters and qualitative indexes of gray-scale ultrasound and SWE of breast cancer lesions and the marginal zones around the lesions have good application value in evaluating Ki-67 expression, among which the maximum diameter, the stiff rim sign, and E2Smax have higher diagnostic efficiency, especially the combination of the stiff rim sign and the maximum diameter, which can provide an objective and reliable basis for early diagnosis of tumor invasiveness and prognosis evaluation after treatment.