对比研究全视野乳腺X线摄影（FFDM）、自动乳腺容积超声（AB US）、乳腺动态增强磁共振（MRI）对于乳腺局部结构扭曲病变良恶性的诊断价值。

回顾性分析2015年1月至2019年12月在西湖大学医学院附属杭州市第一人民医院行FFDM检查，表现为结构扭曲的171例乳腺疾病患者的临床、影像及病理资料，其中行AB US检查171例、MRI检查108例。对FFDM、AB US、MRI影像再分析并给出乳腺影像报告和数据系统（BI-RADS）分类。以病理结果为判断良恶性的金标准；部分无病理结果，随访≥2年且病灶影像学特征无改变判读为良性。对比3种影像检查方法对乳腺结构扭曲病变的诊断效能，评估AB US冠状面汇聚征在诊断中的价值。

入组171例患者，143例有病理结果，恶性病变81例，良性病变62例；其余28例随访证实良性。恶性病例中，AB US冠状面有汇聚征的占80.2%（65/81）；良性病例中，AB US冠状面有汇聚征的占45.6%（41/90），乳腺良、恶性病变的冠状面汇聚征差异有统计学意义（P<0.001）。FFDM、AB US、MRI以及FFDM联合AB US诊断乳腺局部结构扭曲病变良恶性的特异度分别为17.78%、37.77%、49.06%、47.78%，差异有统计学意义（P<0.05）。3种影像学检查及AB US联合FFDM检查诊断乳腺局部结构扭曲病变良恶性的敏感度、准确性、阳性预测值、阴性预测值差异均无统计学意义（P>0.05）。

AB US可以提高FFDM表现为乳腺结构扭曲病变的诊断特异度，两者结合可以提高乳腺病变的诊断效能，结合MRI检查有助于减少不必要的有创干预。

To compare the diagnostic value of full-field digital mammography (FFDM), automated breast ultrasound (AB US), and contrast-enhanced magnetic resonance imaging (MRI) in breast lesions with architectural distortion (AD).

A retrospective analysis was performed on the clinical, imaging, and pathological data of 171 lesions diagnosed as having AD on FFDM from January 2015 to December 2019, including 171 patients who underwent AB US examination and 108 patients who underwent contrast-enhanced MRI examination. Surgical or puncture pathological results were used as the gold standard for the diagnosis of the nature (benign or malignant) of the lesions; lesions without pathological results were interpreted as benign when there were no changes in imaging features after ≥2 years of follow-up. The diagnostic efficacy of FFDM, AB US, and contrast-enhanced MRI was calculated. Meanwhile, the retraction phenomenon on the coronal plane of AB US was analyzed.

A total of 171 cases were enrolled, of which 143 had pathological results, including 81 malignant and 62 benign lesions. The remaining 28 cases were proved to be benign by follow-up. The proportion of malignant cases with the retraction phenomenon on the coronal plane of AB US was 80.2% (65/81), which was significantly higher than that [45.6% (41/90)] in benign cases (P<0.001). The differences in specificity among FFDM, AB US, contrast-enhanced MRI, and FFDM combined with AB US (17.78% vs 37.77% vs 49.06% vs 47.78%) were statistically significant (P<0.05), but the sensitivity, accuracy, positive predictive value, and negative predictive value had no significant difference (P>0.05).

AB US combined with FFDM could improve the diagnostic efficacy for breast lesions with AD on FFDM. Negative breast MRI findings in such patients may have help avoid unnecessary interventions.