Zhu Yindi, Jiang Li, Chen Yue-Nan, Wang Mingyue, Hieken Tina J, Pan Mei-Fang, Zhang Dian
Department of Gynecology and Obstetrics, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Ultrasound, Suzhou Xiangcheng People's Hospital, Suzhou, China.
Gland Surg. 2025 Mar 31;14(3):488-497. doi: 10.21037/gs-2025-93. Epub 2025 Mar 26.
The Breast Imaging-Reporting and Data System (BI-RADS) is the primary system for classifying clinical breast lesions. Most early lesions identified via ultrasound are classified as BI-RADS 4A or lower. Although the vast majority of BI-RADS 4A lesions are benign, those lesions still have the possibility of malignancy in clinical practice, which is a controversial and noteworthy issue. This study aimed to assess the diagnostic value of real-time ultrasound elastography (UE) and contrast-enhanced ultrasound (CEUS) in evaluating BI-RADS 4A breast lesions.
A retrospective analysis was conducted of the UE and CEUS data of 52 BI-RADS 4A breast lesions from 52 patients between January 2020 and March 2023. All diagnoses were confirmed by surgical pathology. Lesion characteristics, including the margins, echogenicity, size, microcalcifications, blood flow patterns, UE scores, and CEUS features, were analyzed. CEUS scores were based on a five-point system, and the area under the curve (AUC) was calculated using MedCalc version 19.0.4.
Based on the postoperative pathology, of the 52 lesions, 27 were benign and 25 were malignant. Compared to those with benign lesions, the patients with malignant lesions were older and had larger lesions (P<0.05). Features such as irregular morphology, indistinct margins, increased blood flow, and calcifications were more common in the malignant lesions than the benign lesions (P<0.05). The malignant lesions also had a higher prevalence of inhomogeneous enhancement, vasa vasorum, irregular enhanced morphology, and crab claw-like signs on CEUS than the benign lesions (P<0.05). The diagnostic accuracy of both the UE and CEUS individually was 76.9%, while the diagnostic accuracy of the UE and CEUS combined reached 80.8%. The AUCs of UE, CEUS, and the UE and CEUS combined were 0.761, 0.773, and 0.813, respectively.
UE and CEUS have significant diagnostic value for BI-RADS 4A breast lesions. Combining these techniques improves diagnostic accuracy and can help reduce unnecessary biopsies.
乳腺影像报告和数据系统（BI-RADS）是对临床乳腺病变进行分类的主要系统。通过超声发现的大多数早期病变被分类为BI-RADS 4A或更低级别。尽管绝大多数BI-RADS 4A病变是良性的，但在临床实践中这些病变仍有恶性的可能性，这是一个有争议且值得关注的问题。本研究旨在评估实时超声弹性成像（UE）和超声造影（CEUS）在评估BI-RADS 4A乳腺病变中的诊断价值。
对2020年1月至2023年3月期间52例患者的52个BI-RADS 4A乳腺病变的UE和CEUS数据进行回顾性分析。所有诊断均经手术病理证实。分析病变特征，包括边界、回声、大小、微钙化、血流模式、UE评分和CEUS特征。CEUS评分基于五分制，使用MedCalc 19.0.4版本计算曲线下面积（AUC）。
根据术后病理，52个病变中，27个为良性，25个为恶性。与良性病变患者相比，恶性病变患者年龄更大且病变更大（P<0.05）。形态不规则、边界不清、血流增加和钙化等特征在恶性病变中比良性病变更常见（P<0.05）。恶性病变在CEUS上不均匀强化、血管分支、强化形态不规则和蟹爪样征的发生率也高于良性病变（P<0.05）。UE和CEUS单独的诊断准确率均为76.9%，而UE和CEUS联合的诊断准确率达到80.8%。UE、CEUS以及UE和CEUS联合的AUC分别为0.761、0.773和0.813。
UE和CEUS对BI-RADS 4A乳腺病变具有显著诊断价值。联合使用这些技术可提高诊断准确率，并有助于减少不必要的活检。
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