为了减少对被归类为BI-RADS 4-5的良性乳腺病变进行活组织检查的数量，我们调查了二维和三维切应变弹性成像（2D + 3D SWE）与标准乳腺超声检查（US）相结合在乳腺病变BI-RADS评估中的诊断性能。总共有897个乳腺病变被归类为BI-RADS 3-5，经过标准乳腺超声检查，并通过仅2D SWE和2D + 3D SWE分析进行补充。基于BI-RADS 3的恶性率低于2％的事实，通过SWE评估将由标准乳腺超声检查评估的病变重新分类。经过标准乳腺超声评估，其中268例（46.1％）参与者在BI-RADS 4-5病变中进行了良性活组织检查。通过在2D + 3D SWE重分类中将BI-RADS 3的标准定在120 kPa，将BI-RADS 4a的标准定在90 kPa，有123例（21.2％）参与者进行了良性活组织检查，结果显示降低了54.1％（123比268）。将2D + 3D SWE与标准乳腺超声检查结合用于重分类BI-RADS病变，可以在不明显降低敏感性的情况下减少BI-RADS 4-5病变的良性活组织检查。将2D + 3D SWE与超声结合使用，有效减少了BI-RADS 4-5类乳腺病变的良性活组织检查，有可能提高对乳腺病变的BI-RADS评估的诊断准确性。ChiCTR1900026556主要结论：• 在BI-RADS 4-5类乳腺病变中减少良性活组织检查是必要的。• 使用2D + 3D SWE重分类，BI-RADS 4-5类病变的良性活组织检查减少了54.1％。• 将2D + 3D SWE添加到标准乳腺超声检查中改善了对乳腺病变的BI-RADS评估的诊断性能：特异性从54％增加到79％，阳性预测值从54％增加到71％，敏感性略降（97.2％对比98.7％），阴性预测值略降（98.1％对比98.7％）。© 2023年作者。

To reduce the number of biopsies performed on benign breast lesions categorized as BI-RADS 4-5, we investigated the diagnostic performance of combined two-dimensional and three-dimensional shear wave elastography (2D + 3D SWE) with standard breast ultrasonography (US) for the BI-RADS assessment of breast lesions.A total of 897 breast lesions, categorized as BI-RADS 3-5, were subjected to standard breast US and supplemented by 2D SWE only and 2D + 3D SWE analysis. Based on the malignancy rate of less than 2% for BI-RADS 3, lesions assessed by standard breast US were reclassified with SWE assessment.After standard breast US evaluation, 268 (46.1%) participants underwent benign biopsies in BI-RADS 4-5 lesions. By using separated cutoffs for upstaging BI-RADS 3 at 120 kPa and downstaging BI-RADS 4a at 90 kPa in 2D + 3D SWE reclassification, 123 (21.2%) participants underwent benign biopsy, resulting in a 54.1% reduction (123 versus 268).Combining 2D + 3D SWE with standard breast US for reclassification of BI-RADS lesions may achieve a reduction in benign biopsies in BI-RADS 4-5 lesions without sacrificing sensitivity unacceptably.Combining 2D + 3D SWE with US effectively reduces benign biopsies in breast lesions with categories 4-5, potentially improving diagnostic accuracy of BI-RADS assessment for patients with breast lesions.ChiCTR1900026556 KEY POINTS: • Reduce benign biopsy is necessary in breast lesions with BI-RADS 4-5 category. • A reduction of 54.1% on benign biopsies in BI-RADS 4-5 lesions was achieved using 2D + 3D SWE reclassification. • Adding 2D + 3D SWE to standard breast US improved the diagnostic performance of BI-RADS assessment on breast lesions: specificity increased from 54 to 79%, and PPV increased from 54 to 71%, with slight loss in sensitivity (97.2% versus 98.7%) and NPV (98.1% versus 98.7%).© 2023. The Author(s).