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.