Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Breast Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Cancer Imaging. 2023 Mar 10;23(1):25. doi: 10.1186/s40644-023-00539-w.
Ductal lesions are an important, often overlooked, and poorly understood issue in breast imaging, which have a risk of underlying malignancy ranging from 5 to 23%. Ultrasonography (US), which has largely replaced galactography or ductography, has become an important imaging method to assess patients with ductal lesions. However, it is difficult to distinguish benign from malignant ductal abnormalities only by ultrasonography, most of which are recommended to be at least in subcategory 4A; these require biopsy according to the ACR BI-RADS®atlas 5th Edition-breast ultrasound. Contrast-enhanced ultrasound (CEUS) has been shown to be valuable for differentiating benign from malignant tumors, but its value is unclear in breast ductal lesions. Therefore, the purposes of this study were to explore the characteristics of malignant ductal abnormalities on US and CEUS imaging and the diagnostic value of CEUS in breast ductal abnormalities.
Overall, 82 patients with 82 suspicious ductal lesions were recruited for this prospective study. They were divided into benign and malignant groups according to the pathological results. Morphologic features and quantitative parameters of US and CEUS were analyzed by comparison and multivariate logistic regression to determine the independent risk factors. The diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis.
Shape, margin, inner echo, size, microcalcification and blood flow classification on US, wash-in time, enhancement intensity, enhancement mode, enhancement scope, blood perfusion defects, peripheral high enhancement and boundary on CEUS were identified as features correlated with malignant ductal lesions. However, multivariate logistic regression showed that only microcalcification (OR = 8.96, P = 0.047) and enhancement scope (enlarged, OR = 27.42, P = 0.018) were independent risk factors for predicting malignant ductal lesions. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the ROC curve of microcalcifications combined with an enlarged enhancement scope were 0.895, 0.886, 0.872, 0.907, 0.890, and 0.92, respectively.
Microcalcification and enlarged enhancement scope are independent factors for predicting malignant ductal lesions. The combined diagnosis can greatly improve the diagnostic performance, indicating that CEUS can be useful in the differentiation of benign and malignant lesions to formulate more appropriate management for ductal lesions.
在乳腺影像学中，导管病变是一个重要但经常被忽视且了解甚少的问题，其潜在恶性风险为 5%至 23%。超声检查（US）已在很大程度上取代了乳管造影或乳腺导管造影，已成为评估导管病变患者的重要影像学方法。然而，仅通过超声检查很难区分良性和恶性导管异常，其中大多数被推荐至少归入 4A 亚类；根据 ACR BI-RADS®第 5 版乳腺超声分类标准，这些病变需要进行活检。对比增强超声（CEUS）已被证明对区分良性和恶性肿瘤有价值，但在乳腺导管病变中的价值尚不清楚。因此，本研究旨在探讨 US 和 CEUS 成像中恶性导管异常的特征，以及 CEUS 在乳腺导管病变中的诊断价值。
本前瞻性研究共纳入 82 例 82 个可疑导管病变患者。根据病理结果将其分为良性和恶性两组。通过比较和多因素逻辑回归分析 US 和 CEUS 的形态学特征和定量参数，确定独立的危险因素。通过受试者工作特征（ROC）曲线分析评估诊断性能。
US 上的形态、边缘、内部回声、大小、微钙化和血流分类，CEUS 上的增强开始时间、增强强度、增强模式、增强范围、血流灌注缺损、外周高增强和边界，均被确定为与恶性导管病变相关的特征。然而，多因素逻辑回归显示，仅微钙化（OR=8.96，P=0.047）和增强范围（扩大，OR=27.42，P=0.018）是预测恶性导管病变的独立危险因素。微钙化结合增强范围扩大的敏感性、特异性、阳性预测值、阴性预测值、准确性和 ROC 曲线下面积分别为 0.895、0.886、0.872、0.907、0.890 和 0.92。
微钙化和增强范围扩大是预测恶性导管病变的独立因素。联合诊断可以极大地提高诊断性能，表明 CEUS 可用于区分良性和恶性病变，为导管病变制定更合适的管理方案。
