Jia Chao, Niu Qinghua, Liu Long, Li Gang, Jin Lifang, Du Lianfang, Shi Qiusheng, Li Fan
Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gland Surg. 2023 Jun 30;12(6):824-833. doi: 10.21037/gs-23-165. Epub 2023 Jun 19.
Breast cancer lesions show an expanded range on contrast-enhanced ultrasound (CEUS). Here, we quantitatively analyze this index to explore its effective cutoff value for distinguishing benign and malignant lesions and the corresponding diagnostic performance and investigate its role in prognostic assessment of malignant lesions.
Consecutive patients who underwent CEUS for breast lesions during the period from September 2017 to June 2019 were included. Original CEUS images were selected, displayed in dual-frame mode, and measured when enhancement of the lesion reached its peak. The longitudinal diameter, transverse diameter, and area of the lesion on the two-dimensional images and the corresponding postenhancement images were measured to calculate six indicators: longitudinal diameter increment, transverse diameter increment, area increment, percent increase in longitudinal diameter, percent increase in transverse diameter, and percent increase in area increment. With postoperative pathology as the gold standard, the cutoff values for distinguishing benign and malignant lesions and the correlations of these indicators with pathological subtypes and pathological grades were evaluated.
Malignant lesions showed a more significantly expanded range after enhancement compared to benign lesions, especially in terms of area increase. When the cutoff value of the area increment was set at 0.47 cm for distinguishing between benign and malignant lesions, the area under the curve (AUC) was 0.945, and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.1%, 91.5%, 90.9%, 87.2%, and 93.5%, respectively. The pathologically measured maximum diameter of malignant masses correlated with the percent increase in transverse diameter, area increment, and percent increase in area increment. The longitudinal diameter increment in the luminal A group was significantly smaller than that in the human epidermal growth factor receptor 2 (HER2)+ group. The percent increase in transverse diameter was helpful for predicting the pathological grade of malignant masses. When the cutoff value of the percent increase in transverse diameter was set at 10.84% for pathological grading, the AUC was 0.623, and the sensitivity was 90.8%.
Indicators related to the expanded lesion range on CEUS are helpful in differential diagnosis of benign and malignant lesions and in prognostic assessment of pathological grades.
乳腺癌病灶在超声造影（CEUS）上显示出更大的范围。在此，我们对该指标进行定量分析，以探索其区分良性和恶性病灶的有效临界值及相应的诊断性能，并研究其在恶性病灶预后评估中的作用。
纳入2017年9月至2019年6月期间因乳腺病灶接受CEUS检查的连续患者。选择原始CEUS图像，以双帧模式显示，并在病灶增强达到峰值时进行测量。测量二维图像及相应增强后图像上病灶的纵径、横径和面积，计算六个指标：纵径增加量、横径增加量、面积增加量、纵径增加百分比、横径增加百分比和面积增加百分比增加量。以术后病理作为金标准，评估区分良性和恶性病灶的临界值以及这些指标与病理亚型和病理分级的相关性。
与良性病灶相比，恶性病灶增强后范围扩大更显著，尤其是面积增加方面。当区分良性和恶性病灶的面积增加量临界值设定为0.47 cm时，曲线下面积（AUC）为0.945，灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为90.1%、91.5%、90.9%、87.2%和93.5%。恶性肿块病理测量的最大直径与横径增加百分比、面积增加量和面积增加百分比增加量相关。管腔A型组的纵径增加量明显小于人表皮生长因子受体2（HER2）阳性组。横径增加百分比有助于预测恶性肿块的病理分级。当病理分级的横径增加百分比临界值设定为10.84%时，AUC为0.623，灵敏度为90.8%。
CEUS上与病灶范围扩大相关的指标有助于良性和恶性病灶的鉴别诊断以及病理分级的预后评估。
