Objective: To develop a non-invasive prediction model based on two-dimensional shear wave elastography and conventional ultrasound parameters (Elasticity Combined Ultrasound Predict Model, EUPM) to enhance the accuracy of predicting axillary lymph node metastasis in breast cancer.Methods: This study included 285 breast cancer patients, of which 128 (44.9%) had lymph node metastases. All patients were divided into axillary lymph node metastasis group and non-metastasis group, and divided into training cohort and validation cohort according to the ratio of 7:3, respectively. The basic information of patients, conventional ultrasound parameters of tumours and lymph nodes, and hardness values of tumours were collected, and the conventional ultrasound index model, elasticity index model, and EUPM were constructed to explore the value of 2DSWE and conventional ultrasound parameters in predicting axillary lymph node metastasis of breast cancer.Results: Breast cancer diameter, lymph peak speed (LPS), lymph cortex-medulla ratio (LCMR), and tumor hardness were independent predictors of axillary lymph node metastasis in breast cancer. ROC curve, calibration curve and DCA analyses showed that the EUPM significantly outperformed both the conventional ultrasound index model and the elasticity index model. Similar results were obtained in the validation cohort.Conclusion: EUPM significantly improves the accuracy of predicting axillary lymph node metastasis in breast cancer, providing important information for the development of personalized treatment plans.