Department of Ultrasound, The 2nd Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Clin Hemorheol Microcirc. 2019;72(3):293-303. doi: 10.3233/CH-180495.
To clarify the clinical role of contrast enhanced ultrasound (CEUS) in predicting BI-RADS 4 breast disease.
A total of 92 sites of BI-RADS 4 breast diseases were reassessed by routine ultrasound and CEUS. The main indicators of routine ultrasound, CEUS and the combination of the two modalities were picked up by binary logistic regression analysis, scoring 0 for benign and 1 for malignant characteristics with pathology as referential standard to generate corresponding score systems of them. Finally, the receiver operating characteristic curves (ROC) were applied to compare the diagnostic efficacy of the three score systems.
As pathological results showing, there were 43 malignant and 49 benign sites in total. Binary logistic regression analysis indicated that the margin, micro-calcification, and hyperechoic halo were main indicators for routine ultrasound score system. The scope expansion and pathological vessels in CEUS were main indicators for CEUS score system. The microcalcification, hyperechoic halo, the scope expansion and pathological vessels in CEUS were main indicators for the combination score system of the two modalities. The sensitivity, specificity and the area under ROC curve (AUC) of routine US, CEUS and the combination of the two modalities score systems were 74.4%, 91.8%, 0.885 and 88.4%, 87.8%, 0.901 and 86.0%, 95.9%, 0.937, respectively.
In summary, CEUS is helpful for us to identify malignant disease and plays a supplementary role in predicting BI-RADS 4 breast disease in some extent. The scope expansion and pathological vessels in CEUS may be the most useful indicators.
阐明增强超声（CEUS）在预测 BI-RADS 4 类乳腺疾病中的临床作用。
对 92 个 BI-RADS 4 类乳腺疾病部位进行常规超声和 CEUS 重新评估。通过二元逻辑回归分析提取常规超声、CEUS 及两者联合的主要指标，以病理为参考标准，对良性和恶性特征分别赋值 0 和 1，生成相应的评分系统。最后，应用受试者工作特征曲线（ROC）比较三种评分系统的诊断效能。
病理结果显示，恶性病变 43 处，良性病变 49 处。二元逻辑回归分析表明，边缘、微钙化和高回声晕是常规超声评分系统的主要指标。CEUS 的范围扩大和病理血管是 CEUS 评分系统的主要指标。CEUS 中的微钙化、高回声晕、范围扩大和病理血管是两种模式联合评分系统的主要指标。常规超声、CEUS 和两种模式联合评分系统的灵敏度、特异度和 ROC 曲线下面积（AUC）分别为 74.4%、91.8%、0.885 和 88.4%、87.8%、0.901 和 86.0%、95.9%、0.937。
总之，CEUS 有助于我们识别恶性疾病，并在一定程度上对预测 BI-RADS 4 类乳腺疾病起到补充作用。CEUS 中的范围扩大和病理血管可能是最有用的指标。
