探讨三维反转成像技术能否提高BI-RADS 4类乳腺肿块良恶性的鉴别诊断价值，以减少不必要的活检。

收集2021年9月至2023年6月在安徽医科大学第二附属医院经常规超声诊断为BI-RADS 4类并进行反转成像检查的243例患者的247个乳腺肿块。根据反转图像中肿块内深灰色和黑色区域的分布特征，采用半定量5分反转评分法，并以病理结果为金标准，绘制ROC曲线，对比常规超声与联合三维反转成像技术后对BI-RADS 4类乳腺肿块的诊断效能。

常规超声鉴别BI-RADS 4类乳腺肿块良恶性的ROC曲线下面积（AUC）、准确性、敏感度、特异度、阳性预测值、阴性预测值分别为0.841、83.8%、93.3%、74.8%、77.8%、92.2%；联合诊断后AUC、准确性、敏感度、特异度、阳性预测值、阴性预测值分别为0.887、88.7%、90.0%、87.4%、87.1%、90.2%。联合诊断后有87例BI-RADS 4a类良性肿块降至3类，同时未造成恶性肿块误降为3类而漏诊的情况，可避免84.5%（87/103）的4a类肿块进行不必要的活检。

常规超声联合三维反转成像技术对乳腺肿块良恶性具有良好的诊断效能，尤其特异度和阳性预测值均明显提升，有效减少了4a类肿块不必要的活检。

To investigate whether three-dimensional inversion imaging can improve the diagnosis of the nature of Breast Imaging Reporting and Data System (BI-RADS) category 4 breast masses to reduce unnecessary biopsies.

A total of 247 breast masses were collected from 243 patients who were diagnosed as having BI-RADS category 4 lesions by conventional ultrasound and underwent three-dimensional inversion imaging from September 2021 to June 2023 at the Second Affiliated Hospital of Anhui Medical University. Based on the distribution characteristics of dark grey and black areas within the mass in the inverted images, the diagnostic efficacy of conventional ultrasound alone and combined with three-dimensional inversion imaging for BI-RADS category 4 breast masses was compared by using a semi-quantitative 5-point inversion scoring method and plotting receiver operating characteristic (ROC) curves with pathological findings as the gold standard.

The area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of conventional ultrasound for identifying the nature of BI-RADS category 4 breast masses were 0.841, 83.8%, 93.3%, 74.8%, 77.8%, and 92.2%, respectively; the corresponding values of the combined diagnosis were 0.887, 88.7%, 90.0%, 87.4%, 87.1%, and 90.2%. The combined diagnosis resulted in 87 BI-RADS category 4a benign masses being downgraded to category 3, and did not result in malignant masses mistakenly downgraded to category 3, which would have prevented unnecessary biopsies of 84.5% (87/103) of category 4a masses.

Conventional ultrasound combined with three-dimensional inversion imaging has good diagnostic efficacy for benign and malignant breast masses, significantly improving the diagnosic specificity and positive predictive value and thus effectively reducing unnecessary biopsies of category 4a masses.