Liang Runa, Lian Jun, Zhang Jinhui, Jing Jiayu, Bian Jinxia, Xu Jinzhi, He Xin, Yu Shanshan, Zhou Qi, Jiang Jue
Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Ultrasound, Ankang Central Hospital, Ankang, China.
Front Med (Lausanne). 2024 Dec 24;11:1511200. doi: 10.3389/fmed.2024.1511200. eCollection 2024.
Contrast-enhanced ultrasound (CEUS) shows potential for the differential diagnosis of breast lesions in general, but its effectiveness remains unclear for the differential diagnosis of lesions highly suspicious for breast cancers.
This study aimed to evaluate the diagnostic value of CEUS in differentiating pathological subtypes of suspicious breast lesions defined as category 4 of US-BI-RADS.
The dataset of 150 breast lesions was prospectively collected from 150 patients who underwent routine ultrasound and CEUS examination and were highly suspected of having breast cancers. All lesions were pathologically confirmed by US-guided needle biopsy and surgery. The qualitative features and the quantitative parameters of CEUS of these breast lesions were analyzed. The CEUS and biopsy examinations were performed after informed consent.
In the qualitative features, crab clam-like enhancement, the presence of more than two enhanced vessels within lesions, and surrounding enriched vessels inserting into lesions were able to differentiate atypical fibroadenomas (FIB) and mass-like non-puerperal mastitis (NPM) from invasive ductal carcinomas (IDC) and ductal carcinomas (DCIS) ( < 0.05). The enlarged scope, irregular shape, and perfusion deficiency were valuable to the differential diagnosis of FIB from the others ( < 0.05). In the four quantitative parameters of CEUS, only the peak intensity (IMAX) contributed to the differential diagnosis between malignant and benign tumors ( < 0.05, ROCAUC: 0.61, sensitivity: 60.4% and specificity: 65.9%, accuracy: 62.1%). However, IMAX did not show any difference in the paired comparison of IDC, DCIS, FIB, and NPM ( > 0.05). The logistic regression analysis results showed that heterogeneous perfusion, crab clam-like enhancement, and partial_ IMAX were independent risk factors for benign and malignant breast lesions . The area under a receiver operating characteristic of the integrated model was 0.89. In the diagnosis of benign and malignant pathological subtypes of breast lesions, independent risk factors and integrated models had no statistical significance in the diagnosis of IDC and DCISs, FIB, and NPM ( > 0.05).
Some qualitative risk features of CEUS can distinguish malignant breast lesions from NPM and atypical FIB with a high score of US-BI-RADS, aiding physicians to reduce the misdiagnosis of suspicious breast lesions in clinical practice.
一般而言，超声造影（CEUS）在乳腺病变的鉴别诊断中显示出潜力，但其在高度怀疑为乳腺癌的病变鉴别诊断中的有效性仍不明确。
本研究旨在评估CEUS在鉴别美国放射学会乳腺影像报告和数据系统（US-BI-RADS）4类可疑乳腺病变病理亚型中的诊断价值。
前瞻性收集150例接受常规超声和CEUS检查且高度怀疑患有乳腺癌患者的150个乳腺病变数据集。所有病变均经超声引导下穿刺活检和手术病理证实。分析这些乳腺病变CEUS的定性特征和定量参数。在获得知情同意后进行CEUS和活检检查。
在定性特征方面，蟹钳样增强、病灶内有两条以上增强血管以及周围有丰富血管穿入病灶能够将非典型纤维腺瘤（FIB）和肿块样非产褥期乳腺炎（NPM）与浸润性导管癌（IDC）和导管原位癌（DCIS）区分开来（P<0.05）。范围扩大、形态不规则和灌注不足对FIB与其他病变的鉴别诊断有价值（P<0.05）。在CEUS的四个定量参数中，只有峰值强度（IMAX）对良恶性肿瘤的鉴别诊断有贡献（P<0.05，受试者工作特征曲线下面积：0.61，灵敏度：60.4%，特异度：65.9%，准确度：62.1%）。然而，IMAX在IDC、DCIS、FIB和NPM的配对比较中未显示出任何差异（P>0.05）。逻辑回归分析结果显示，不均匀灌注、蟹钳样增强和部分IMAX是乳腺良恶性病变的独立危险因素。综合模型的受试者工作特征曲线下面积为0.89。在乳腺病变良恶性病理亚型的诊断中，独立危险因素和综合模型在IDC、DCIS、FIB和NPM的诊断中无统计学意义（P>0.05）。
CEUS的一些定性风险特征可以将乳腺恶性病变与NPM和US-BI-RADS分类为4类的非典型FIB区分开来，有助于医生在临床实践中减少可疑乳腺病变的误诊。
