<p>A multicenter study of a contrast-enhanced ultrasound diagnostic classification of breast lesions</p>

Abstract

PurposeTo evaluate a classification model of contrast-enhanced ultrasound (CEUS) and examine the characteristics of patients with false-negative diagnosis.Patients and methodsA retrospective secondary analysis of a multicenter trial of CEUS for breast cancer diagnosis (from August 2015 to April 2017) was undertaken. Patients (n=1,023) with Breast Imaging Reporting and Data System 4–5 lesions on B-mode ultrasound underwent CEUS. Pathological diagnoses were available from surgical or biopsy specimens for correlation. Lesion maximum diameter (LMD), distance to the papilla (DtP), distance from the superficial edge of the lesion to the skin (DtS), distance from the deep edge of the lesion to the pectoralis muscle (DtPM), and body mass index (BMI) were evaluated.ResultsMedian age and BMI were 48.0 and 41.2 years and 23.2 and 22.4 kg/m2 for patients with malignant and benign lesions, respectively. Overall sensitivity, specificity, and accuracy of CEUS for malignancy were 89.4%, 65.3%, and 75.8%, respectively. The patients with true-positive and false-negative diagnosis (ie, with malignant lesion) were older than those with false-positive and true-negative diagnosis (ie, with benign lesion). Patients with true-positive and false-positive diagnoses had higher BMI than patients with true-negative and false-negative diagnoses (P=0.004). Patients with true-positive and false-negative diagnoses had larger LMD and DtP, as well as smaller DtS and DtPM.ConclusionOlder age, higher BMI, larger LMD and DtP, and smaller DtS and DtPM were associated with malignant lesions on CEUS. Patients with these characteristics should undergo further imaging.

Prospective evaluation of contrast-enhanced ultrasound of breast BI-RADS 3–5 lesions

“…in distinguishing lesions BI-RADS category 3 and 4 [6]. Thus, CEUS may reduce the number of core-needle biopsies of benign lesions in the future [7], especially in older patients with higher body mass index larger maximal lesion diameter and distance to pappila [8]. Compared to magnetic resonance, CEUS is a relatively easily accessible, fast and cost-effective method well-suited to become a part of the diagnostic algorithm of breast examination before biopsy.…”

Factors influencing the performance of a diagnostic model including contrast-enhanced ultrasound in 1023 breast lesions: comparison with histopathology

“…Two different physicians from each center (each with >15 years of experience with breast US and 2 years of experience with CEUS) evaluated all CEUS images without performing the exam and without knowledge of patients' clinical data, according to the developing CEUS prediction model, as we previously described (15,16). Disagreements were resolved by a third-party appraisal.…”

“…Based on qualitative analyses of 10 enhancement characteristics, our team generated a CEUS prediction model and evaluated its diagnostic performance. Our initial multicenter study data had shown the prediction model exhibited excellent sensitivity and negative predictive value (89.4% & 88.9%), which was better than the performance of mammography (75% sensitivity) (14,15). At the same time, we also wanted to explore how patient and lesion characteristics (including patient age, BMI, location and size of breast lesions) may affect the enhancement pattern and the accuracy.…”

Determining whether the diagnostic value of B-ultrasound combined with contrast-enhanced ultrasound and shear wave elastography in breast mass-like and non-mass-like lesions differs: a diagnostic test

“…Blood perfusion in breast lesions can be observed by CEUS (14). Blood perfusion in the lesion tends to affect its growth, development, infiltration, and metastasis (15,16). CEUS can display microbubbles in the time dimension, reflecting the blood supply in the scanning area and more accurately representing the size of the lesion (17).…”