Value of multimodal imaging in the diagnosis of breast sclerosing adenosis associated with malignant lesions

Abstract

Aim To explore the diagnostic value of multimodal imaging techniques, including automatic breast volume scanner (ABVS), mammography (MG), and magnetic resonance (MRI) in breast sclerosing adenosis (SA) associated with malignant lesions. Methods From January 2018 to October 2020, 76 patients (88 lesions) with pathologically confirmed as SA associated with malignant or benign lesions were retrospective analyzed. All patients completed ABVS examination, 58 patients (67 lesions) with MG and 50 patients (62 lesions) with MRI were also completed before biopsy or surgical excision, of which, six patients (eight lesions) diagnosed as Breast Imaging Reporting and Data System (BI‐RADS) category 3 by all imaging examinations underwent surgical excision without biopsy, other 70 patients (80 lesions) with BI‐RADS category 4 or above by any imaging examination completed biopsy, including 65 patients (75 lesions) were further surgical excised and the other five patients (five lesions) were just followed up. All lesions were retrospectively described and classified, and were divided into benign group and malignant group according to their pathological results. Image features of different examination methods between the two groups were compared and analyzed. A ROC curve was established using the sensitivity of BI‐RADS categories to predict malignant lesions in different imaging techniques as the ordinate and 1‐specificity as the abscissa. Results 88 lesions including 26 purely SA and 45 SA associated with benign lesions were classified as benign group, and the remaining 17 SA associated with malignant lesions were classified as malignant group. On ABVS, 40 mass lesions, their heterogeneous echo, not circumscribed margin and coronal convergence signs were statistically significant for malignant lesions (p < .05), but the remain 48 nonmass lesions lack specific sonographic features. On MG, 12 showed negative results, 55 showed with microcalcification, mass, structural distortion, and asymmetric density shadow, of which 11 lesions had the above two signs at the same time, but only microcalcification had statistical difference between the two groups. 35 mass enhanced lesions and 27 nonmass enhanced lesions on MRI, but there were no significant difference between their pathological results. Time signal intensity curves showed no differences, but ADC value <1.10 × 10−3 mm2/s is more significant in malignant lesions (p < .05). The area under the ROC curve (AUC) of BI‐RADS classification of ABVS, MG, and MRI in the diagnosis of malignant lesions were 0.611, 0.474, and 0.751, respectively, and the AUC of the combined diagnosis of the three was 0.761. Conclusion Mass lesions with heterogeneous echo, not circumscribed margin and coronal convergence sign on ABVS, microcalcification on MG and the ADC value <1.10 × 10−3 mm2/s on MRI are significant signs for SA associated with malignant lesions. The combined diagnosis of the three methods was the highest, and the following were MRI, ABVS, and MG. Therefore, be cognizant of significant...

Multimodal ultrasound imaging for diagnostic differentiation of sclerosing adenosis from invasive ductal carcinoma

“…The retraction phenomenon could be found in the coronal plane, which has been described to have a superior 100.0% specificity and 80.0% sensitivity in detecting breast cancer, with a high 91.4% accuracy in differentiating malignant lesions from benign lesions ( 20 ). In our study, SA exhibited a significantly less likelihood of demonstrating the retraction phenomenon in the coronal planes than did IDC (P<0.05), which is consistent with Chen et al ’s findings ( 6 ). Of note, the occurrence rate of the retraction phenomenon in SA was 18.52% in the coronal plane as achieved by ABVS, which could be mainly related to the growth of stoma fiber hyperplasia in adjacent glands and fat tissue forming the “pseudo infiltration” ( 21 ).…”

“…To best of our knowledge, no study has indicated the diagnostic efficiency. Chen et al ( 6 ) found that the integrated application of ABVS, MG, and MRI could improve the preoperative evaluation of SA, while the analyzed masses were SA lesions associated with malignant or benign lesions. To our knowledge, this is the first multicenter study to employ multimodal ultrasound imaging (ABVS, EI, and CDFI) for distinguishing SA from IDC.…”

“…ABVS was previously used to evaluate all types of breast lesions, while only SA and IDC lesions were assessed in our study. The characteristics of SA and IDC typically lead to misdiagnosis, and it is difficult to differentiate them only via ABVS ( 6 ).…”

“…At present, preoperative diagnosis of SA is highly challenging, especially as it relates to differentiating SA from IDC ( 1 , 6 ). Although mammography (MG) and conventional ultrasound, the two most commonly used diagnostic techniques for breast diseases, have progressed consistently, it remains difficult to distinguish between SA and IDC based on imaging findings ( 7 ).…”