reast cancer is the most frequent female malignancy, and its incidence is second overall, constituting 10.9% of cancers. 1 Although the incidence of breast cancer is higher in the United States and northern Europe than in Asia, 2-4 economic development and lifestyle changes in China have substantially increased its incidence, 5 and breast cancer is now the most common malignancy in China. The cure rate for early-stage breast cancer can be up to 97%, although the cure rate for later-stage breast cancer is only 40%. 6 In addition, because the clinical manifestations of early-stage breast cancer are not typical, therapeutic efforts are greatly aided by early detection, diagnosis, and treatment. 6 Jian Wang, MD, PhD, Chunsong Kang, MD, PhD, Xiaofang Liu, MD, Tingting Li, MD, Yu Wang, MD, Tinghua Feng, MD, Zhaojun Li, MD, PhD, Jiping Xue, MD, Kailing Shi, MD Received March 16, 2012,
ORIGINAL RESEARCHObjectives-We sought to summarize the features of radiofrequency ultrasonic local estimator (RULES) images of benign and malignant masses and to explore the diagnostic value of RULES scores to identify breast lumps.Methods-A total of 81 women with a mean age ± SD of 41.33 ± 12.03 years (range, 19-68 years) with 82 lesions seen at our hospital were included in this study. Inclusion criteria were Breast Imaging Reporting and Data System grade 2 to 5 breast lesions, preoperative 2-dimensional (2D) ultrasound (US) examinations and RULES image acquisition, no treatment before the US examinations, surgical resection in our hospital, and histopathologic results. Each RULES characteristic was scored on the basis of expected values for malignant characteristics, and this RULES scoring system was assessed by a receiver operating characteristic curve.Results-Of the 82 lesions, 45 were benign, and 37 were malignant. Malignancy was associated with multiple colors, red as the main color, colors distributed in 3 or more locations, aggregated colors, and more than half of the area filled with colors. A RULES score of 7 had the highest sum of sensitivity (67.6%) and specificity (95.6%) and the highest accuracy (82.9%) for diagnosis of malignancy. When 2D US imaging a Breast Imaging Reporting and Data System category of 4 was combined with a RULES score of 4 to detect breast cancer, the sensitivity was 83.8%; the specificity was 93.3%; and the accuracy increased to 89.0%.Conclusions-The use of RULES images and characteristics is helpful in differentiating benign and malignant breast lesions. Diagnostic accuracy can be improved by combining 2D US imaging and RULES.