研究乳腺周边组织进行剪切波弹性成像（SWE）诊断结节良恶性的价值。

选取浙江大学医学院附属第四医院2020年1月至2020年12月在甲乳外科因乳腺肿块而行穿刺活检或手术的女性患者。进行SWE检查，得到肿块内部的杨氏模量平均值（E-mean）、最大值（E-max）、最小值（E-min）和标准差（E-SD）；启动“shell”功能，先后将“shell”值调节为0.5 mm、1 mm、2 mm，得到肿块周边0.5 mm、1 mm、2 mm的E-mean、E-max、E-min和E-SD。根据最终病理学结果对比4组数据并绘制ROC曲线。

共计纳入68例患者76个病灶，病理证实，76个肿块中良性肿块44个，恶性肿块32个。恶性肿块内部和肿块周边0.5 mm、1 mm、2 mm的E-mean、E-max、E-SD大于良性肿块，差异有统计学意义（P＜0.05）；良恶性肿块内部和肿块周边0.5 mm、1 mm、2 mm的E-min差异无统计学意义（P＞0.05）。分别绘制ROC曲线可知，肿块内部E-mean、E-max、E-SD诊断肿块良恶性的最佳截断值分别为35.14 kPa、80.46 kPa、11.67 kPa，此时AUC分别为0.785、0.824、0.801。肿块周边0.5 mm区域E-mean、E-max、E-SD诊断肿块良恶性的最佳截断值分别为39.44 kPa、86.15 kPa、14.02 kPa，此时AUC分别为0.770、0.835、0.817。肿块周边1 mm区域E-mean、E-max、E-SD诊断肿块良恶性的最佳截断值分别为41.68 kPa、90.46 kPa、15.98 kPa，此时AUC分别为0.806、0.886、0.825。肿块周边2 mm区域E-mean、E-max、E-SD诊断肿块良恶性的最佳截断值分别为44.16 kPa、95.45 kPa、16.81 kPa，此时AUC分别为0.821、0.926、0.842。综合所有数据，肿块周边2 mm区域E-max的AUC最大，诊断价值最高，此时敏感度为93.75%，特异度为93.18%。

乳腺周边组织行SWE诊断结节良恶性的效能高于内部组织，其中，“shell”值取2 mm且使用E-max作为诊断参数时诊断效能最高。

To study the value in the diagnosis of benign and malignant nodules of shear wave elastography (SWE) in the surrounding tissues of the breast.

Female patients who underwent needle biopsy or surgery for breast masses in the Fourth Affiliated Hospital, Zhejiang University School of Medicine from January 2020 to December 2020 were selected. They were performed SWE inspection and got the average (E-mean), maximum (E-max), minimum (E-min) and standard deviation (E-SD) of Young's modulus inside the mass. Then, we started the "shell" function and adjusted the "shell" value to 0.5 mm, 1 mm, and 2 mm successively to obtain E-mean, E-max, E-min and E-SD of 0.5 mm, 1 mm, 2 mm around the mass. According to the final pathology results, the four sets of data were compared and the ROC curves were drawn.

A total of 68 patients with 76 lesions were included. Pathologically, among 76 masses, there were 44 benign masses and 32 malignant masses. E-mean, E-max and E-SD of 0.5 mm, 1 mm, 2 mm around and inside the malignant mass were higher than those of benign masses. The difference was statistically significant (P＜0.05). There was no significant difference in E-min between benign and malignant tumors within and 0.5mm, 1mm, and 2mm around the tumor (P＞0.05). According to the ROC curve separately, it could be seen that the best cut-off values of E-mean, E-max and E-SD inside the tumor for diagnosing benign and malignant tumors were 35.14 kPa, 80.46 kPa, 11.67 kPa, respectively. At this time, the AUC were 0.785, 0.824, 0.801, respectively. The best cut-off values of E-mean, E-max, and E-SD in the 0.5 mm area around the mass for diagnosing benign and malignant masses were 39.44 kPa, 86.15 kPa, and 14.02 kPa, respectively. At this time, the AUC were 0.770, 0.835, 0.817, respectively. The best cut-off values of E-mean, E-max, and E-SD in the 1mm area around the tumor for diagnosing benign and malignant tumors were 41.68 kPa, 90.46 kPa, and 15.98 kPa, respectively. At this time, the AUC were 0.806, 0.886, 0.825, respectively. The best cut-off values of E-mean, E-max, and E-SD in the 2mm area around the mass for diagnosing benign and malignant masses were 44.16 kPa, 95.45 kPa, and 16.81 kPa, respectively. At this time, the AUC were 0.821, 0.926, 0.842, respectively. Combining all the data, the AUC of E-max in the 2 mm area around the mass was the largest and the diagnostic value was the highest. At this time, the sensitivity was 93.75% and the specificity was 93.18%.

The effectiveness of SWE in the diagnosis of benign and malignant nodules in the surrounding tissues of the breast is higher than that of the internal tissues. Among them, when the "shell" takes 2 mm, the diagnostic efficiency is the highest and E-max is used as the diagnostic parameter.