Department of Ultrasound Diagnosis Abdomen, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China.
Tumori. 2021 Oct;107(5):424-431. doi: 10.1177/0300891620965710. Epub 2020 Oct 30.
To explore the value of contrast-enhanced malignancy imaging features in secondary grade diagnosis of Breast Imaging Reporting and Data System for Ultrasonography (BI-RADS-US) type 4 breast lesions.
After initial diagnosis by ultrasound, 124 BI-RADS-US type 4 patients with 130 lesions were examined by contrast-enhanced ultrasound (CEUS) and were classified again before surgery according to five contrast-enhanced malignancy imaging features: inhomogeneous enhancement, peripheral ring-like enhancement, expansive enhancement, internal filling defects, and surrounding radioactive convergence. Lesions with no contrast-enhanced features of malignancy were categorized as type 3; lesions with one, two, or three features of malignancy were categorized as type 4A, 4B, or 4C, respectively; and lesions with four or more indices of malignancy were categorized as type 5. The value of contrasted imaging features of malignancy in diagnosing BI-RADS-US type 4 breast lesions was analyzed.
The accuracy of CEUS diagnosis for type 3 lesions was 93.8% (46/49), 76.9% (10/13) for type 4A, 71.4% (5/7) for type 4B, 75.0% (9/12) for type 4C, and 93.8% (46/49) for type 5 lesions. The sensitivity of CEUS in diagnosing malignant lesions was 90.4%, specificity was 83.6%, and accuracy was 86.9%. CEUS decreased the benign lesion biopsy ratio to 68.5% (46/67) and increased the diagnosis ratio of malignant lesions to 73.0% (46/63).
CEUS can further optimize the classification of BI-RADS-US type 4 breast lesions and may provide a better reference basis for clinical diagnosis and treatment of those breast lesions.
探讨超声影像报告与数据系统（BI-RADS-US）4 类乳腺病变增强恶性影像特征在二级诊断中的价值。
124 例 BI-RADS-US 4 类患者的 130 个病灶经超声初诊后，行超声造影（CEUS）检查，术前根据 5 项增强恶性影像特征再次分类：不均匀增强、周边环状增强、膨胀性增强、内部充盈缺损和周围放射性聚集。无恶性增强特征的病灶归类为 3 类；有 1、2、3 项恶性增强特征的病灶分别归类为 4A、4B、4C 类；有 4 项或更多恶性指标的病灶归类为 5 类。分析恶性增强影像特征在诊断 BI-RADS-US 4 类乳腺病变中的价值。
CEUS 诊断 3 类病变的准确率为 93.8%（46/49），4A 类为 76.9%（10/13），4B 类为 71.4%（5/7），4C 类为 75.0%（9/12），5 类为 93.8%（46/49）。CEUS 诊断恶性病变的灵敏度为 90.4%，特异度为 83.6%，准确率为 86.9%。CEUS 将良性病变活检率降低至 68.5%（46/67），增加恶性病变诊断率至 73.0%（46/63）。
CEUS 可进一步优化 BI-RADS-US 4 类乳腺病变的分类，为临床诊断和治疗此类乳腺病变提供更好的参考依据。
