中文摘要：

目的：借鉴乳腺影像报告和数据系统（BI-RADS），建立超声诊断体系，并探讨其在乳腺癌鉴别诊断中的临床应用价值。方法：对1637例患者（1895个病灶）进行常规超声及超声弹性成像（uE）检查，借鉴BI-RADS建立超声诊断体系对肿块进行分类评估：参照Adler半定量法判断病灶的血供情况，根据改良5分法进行UE评分。构建受试者工作特征曲线（ROC曲线），比较BI-RADS分类与超声诊断体系对乳腺肿块的鉴别诊断价值。结果：（1）诊断乳腺癌阳性预测值较高的二维超声（2DUS）征象依次为：毛刺或蟹足征、与皮肤不平行、微钙化、成角征、后方回声衰减等。（2）超声诊断体系诊断乳腺病变的ROC曲线下面积（AUC）高于BI-RADS分类（0．894VS.0.926），两者比较差异有统计学意义（P〈0．001）。结论：超声诊断体系在乳腺良、恶性病变的鉴别诊断中具有较高的应用价值，可减少不必要的术前活检。

英文摘要：

Objective： To evaluate the value of ultrasound diagnostic system, which was established refer- ring to the breast imaging reporting and data system （BI-RADS）, in the differential diagnosis of breast masses. Methods： A total of 1, 895 breast lesions among 1, 637 patients were examined by conventional ultrasound and ultrasonic elastography （UE）. Breast lesions were classified and evaluated by ultrasound di- agnostic system established referring to BI-RADS： the blood supply in lesions was rated with the Adler semi-quantitative method and the mass elasticity was graded by the improved 5-point scoring system with UE. The diagnostic value of BI-RADS classification and ultrasound diagnostic system was compared by re- ceiver operating characteristic curve （ROC）. Results： （1） The two-dimensional ultrasound （2DUS） signs of most positive predictive value in the diagnosis of breast cancer were as follows： spiculated margin, not parallel orientation, microcalcifications, angular and decreased posterior echoes. （2） The area under ROC curve of ultrasound diagnostic system was significantly higher than that of BI-RADS classification （0. 894 vs. 0. 926, P〈0. 001）. Conclusion： Ultrasound diagnosis system had high clinical value in the differential diagnosis of benign and malignant breast lesions and could avoid the unnecessary preoperative biopsy.