Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China.
Department of Ultrasound, Shanghai Ruijin Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China.
Eur J Radiol. 2024 Nov;180:111687. doi: 10.1016/j.ejrad.2024.111687. Epub 2024 Aug 20.
To evaluate the added value of contrast-enhanced ultrasound (CEUS) on top of breast conventional imaging for predicting the upgrading of ductal carcinoma in situ (DCIS) to invasive cancer after surgery.
This retrospective study enrolled 140 biopsy-proven DCIS lesions in 138 patients and divided them into two groups based on postoperative histopathology: non-upgrade and upgrade groups. Conventional ultrasound (US), mammography (MMG), CEUS and clinicopathological (CL) features were reviewed and compared between the two groups. The predictive performance of different models (with and without CEUS features) for histologic upgrade were compared to calculate the added value of CEUS.
Fifty-nine (42.1 %) lesions were histologically upgraded to invasive cancer after surgery. By logistic regression analyses, we found that high-grade DCIS at biopsy (P=0.004), ultrasonographic lesion size > 20 mm (P=0.007), mass-like lesion on US (P=0.030), the presence of suspicious calcification on MMG (P=0.014), the presence of perfusion defect (P=0.005) and the area under TIC>1021.34 ml (P<0.001) on CEUS were six independent factors predicting concomitant invasive components after surgery. The CL+US+MMG model made with the four predictors in the clinicopathologic, US and MMG categories yielded an area under the receiver operating curve (AUROC) value of 0.759 (95 % CI: 0.680-0.828) in predicting histological upgrade. The combination model built by adding the two CEUS predictors to the CL+US+MMG model showed higher predictive efficacy than the CL+US+MMG model (P=0.018), as the AUROC value was improved to 0.861 (95 % CI: 0.793-0.914).
The addition of contrast-enhanced ultrasound to breast conventional imaging could improve the preoperative prediction of an upgrade to invasive cancer from CNB -proven DCIS lesions.
评估对比增强超声（CEUS）在乳腺常规成像基础上对预测导管原位癌（DCIS）术后升级为浸润性癌的附加价值。
本回顾性研究纳入了 138 例经活检证实的 140 个 DCIS 病变患者，并根据术后组织病理学将其分为两组：非升级组和升级组。回顾并比较了两组的常规超声（US）、乳腺 X 线摄影（MMG）、CEUS 及临床病理（CL）特征。比较不同模型（有和无 CEUS 特征）对组织学升级的预测性能，以计算 CEUS 的附加价值。
术后 59 个（42.1%）病变组织学升级为浸润性癌。通过逻辑回归分析，我们发现活检时高级别 DCIS（P=0.004）、US 上病变直径>20mm（P=0.007）、US 上呈肿块样病变（P=0.030）、MMG 上存在可疑钙化（P=0.014）、CEUS 上存在灌注缺损（P=0.005）和 TIC 下面积>1021.34ml（P<0.001）是术后伴有浸润性成分的六个独立预测因素。由 CL、US 和 MMG 类别中的四个预测因子构成的 CL+US+MMG 模型，在预测组织学升级方面的受试者工作特征曲线下面积（AUROC）值为 0.759（95%CI：0.680-0.828）。将 CL+US+MMG 模型中添加的两个 CEUS 预测因子构建的联合模型，其预测效能优于 CL+US+MMG 模型（P=0.018），AUROC 值提高到 0.861（95%CI：0.793-0.914）。
在乳腺常规成像中加入对比增强超声可以提高术前对从经穿刺活检证实的 DCIS 病变升级为浸润性癌的预测。
