Abstract：Objective Investigating the value of angio planewave ultrasensitive imaging (AP)

real-time shear wave elastography (SWE) and their combined application in the diagnosis of breast cancer. Methods 101 breast nodes with conventional ultrasound BI-RADS classification 3-5 were included

and AP imaging was performed on the nodes

and semi-quantitative blood flow grading and microvascular configuration typing were performed according to blood flow characteristics. Switch to SWE mode

obtain stable elastic images and then analyze to get SWE color typing and perform quantitative analysis to obtain Young's modulus values Emax

Emean. Using pathological findings as the gold standard

ROC curves of relevant parameters were plotted to analyze and compare the difference in efficacy of AP and SWE alone and in combination for the diagnosis of breast cancer. Results Emax

Emean

SWE typing

AP typing and AP grading were significantly higher in malignant breast lesions than in benign lesions (all P < 0.001). In the AP semi-quantitative blood flow grading

benign tumors are dominated by a lack of blood supply and malignant tumors are dominated by a rich blood supply. In microvascular configuration typing benign tumors are thought to be predominantly avascular

linear

and dendritic blood flow

while malignant tumors are predominantly stump and crab foot type. AP microvascular configuration typing method was superior to the semi-quantitative grading method of blood flow (P<0.05). The diagnostic efficacy of SWE quantitative analysis Emax was higher than that of Emean (P<0.05). SWE color typing is predominantly uniform blue or mostly blue for benign tumors

and restricted color changes at the edges or uneven color changes within and around malignant tumors. In the SWE color typing

benign tumors show predominantly uniform blue color or mostly blue color

and malignant tumors show predominantly restricted color changes at the edges or uneven color changes inside. The AUCs of AP typing

Emax and the combination of the two in diagnosing breast cancer were 0.898

0.918 and 0.945. Conclusion Both AP and SWE have good differential diagnostic ability for breast tumors

and their combined application can significantly improve the diagnostic efficacy of breast cancer.