The clinical value of conventional ultrasound combined with contrast-enhanced ultrasound in the evaluation of BI-RADS 4 lesions detected by magnetic resonance imaging

Current status and future perspectives of contrast-enhanced ultrasound diagnosis of breast lesions

Advances in various imaging modalities for breast lesions have improved diagnostic capabilities not only for tumors but also for non-tumorous lesions. Contrast-enhanced ultrasound (CEUS) plays a crucial role not only in the differential diagnosis of breast lesions, identification of sentinel lymph nodes, and diagnosis of lymph node metastasis but also in assessing the therapeutic effects of neoadjuvant chemotherapy (NAC). In CEUS, two image interpretation approaches, i.e., qualitative analysis and quantitative analysis, are employed and applied in various clinical settings. In this paper, we review CEUS for breast lesions, including its various applications.

Value of inversion imaging to diagnosis in differentiating malignant from benign breast masses

BACKGROUND

We aimed to evaluate the added value of inversion imaging in differentiating between benign and malignant breast masses when combined with the Breast Imaging Reporting and Data System (BI-RADS).

METHODS

A total of 364 patients with 367 breast masses (151 benign and 216 malignant) who underwent conventional ultrasound and inversion imaging prior to breast surgery were included. A 5-point inversion score (IS) scale was proposed based on the masses' internal echogenicity and distribution characteristics in the inversion images. The combination of IS and BI-RADS was compared with BI-RADS alone to evaluate the value of inversion imaging for breast mass diagnosis. The diagnostic performance of the BI-RADS and its combination with IS for breast masses were analyzed using area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS

The IS for malignant breast masses (3.96 ± 0.77) was significantly higher than benign masses (2.58 ± 0.98) (P < 0.001). The sensitivity, specificity, accuracy, PPV, and NPV of BI-RADS were 86.1%, 81.5%, 84.2%, 86.9%, and 80.4%, respectively, and an AUC was 0.909. By compared with BI-RADS, 72 breast masses were downgraded from suspected malignancy to benign, and 6 masses were upgraded from benign to suspected malignancy. Thus, the specificity was increased from 81.5 to 84.8%, it allows 72 benign masses avoid biopsy.

CONCLUSION

The combination of inversion imaging with BI-RADS can effectively improve the diagnostic efficacy of breast masses, and inversion imaging could help benign masses avoid biopsy.

Correlation between conventional ultrasound features combined with contrast-enhanced ultrasound patterns and pathological prognostic factors in malignant non-mass breast lesions

OBJECTIVE

To investigate the correlation between ultrasound performance and prognostic factors in malignant non-mass breast lesions (NMLs).

MATERIALS AND METHODS

This study included 106 malignant NMLs in 104 patients. Different US features and contrast enhancement patterns were evaluated. Prognostic factors, including histological types and grades, axillary lymph node and peritumoral lymphovascular status, estrogen and progesterone receptor status and the expression of HER-2 and Ki-67 were determined. A chi-square test and logistic regression analysis were used to analyse possible associations.

RESULTS

Lesion size (OR: 3.08, p = 0.033) and posterior echo attenuation (OR: 8.38, p < 0.001) were useful in reflecting malignant NMLs containing an invasive carcinoma component. Posterior echo attenuation (OR: 7.51, p = 0.003) and unclear enhancement margin (OR: 6.50, p = 0.018) were often found in tumors with axillary lymph node metastases. Peritumoural lymphovascular invasion mostly exhibited posterior echo attenuation (OR: 3.84, p = 0.049) and unclear enhancement margin (OR: 8.68, p = 0.042) on ultrasound images. Perfusion defect was a comparatively accurate enhancement indicator for negative ER (OR: 2.57, p = 0.041) and PR (OR: 3.04, p = 0.008) expression. Calcifications (OR: 3.03, p = 0.025) and enlarged enhancement area (OR: 5.36, p = 0.033) imply an increased risk of positive HER-2 expression. Similarly, Calcifications (OR: 4.13, p = 0.003) and enlarged enhancement area (OR: 11.05, p < 0.001) were valid predictors of high Ki-67 proliferation index.

CONCLUSION

Ultrasound performance is valuable for non-invasive prediction of prognostic factors in malignant NMLs.

Comparison and risk factors analysis of multiple breast cancer screening methods in the evaluation of breast non-mass-like lesions

OBJECTIVE

To compare multiple breast cancer screening methods for evaluating breast non-mass-like lesions (NMLs), and investigate new best screening method for breast non-mass-like lesions and the value of the lexicon of ACR BI-RADS in NML evaluation.

METHODS

This retrospective study examined 253 patients aged 24-68 years who were diagnosed with breast NMLs and described the lexicon of ACR BI-RADS from April 2017 to December 2019. All lesions were evaluated by HHUS, MG, and ABUS to determine BI-RADS category, and underwent pathological examination within six months or at least 2 years of follow-up. The sensitivity, specificity, accuracy, positive predictive values (PPV), and negative predictive values (NPV) of MG, HHUS and ABUS in the prediction of malignancy were compared. Independent risk factors for malignancy were assessed using non-conditional logistic regression.

RESULTS

HHUS, MG and ABUS findings significantly differed between benign and malignant breast NML, including internal echo, hyperechoic spot, peripheral blood flow, internal blood flow, catheter change, peripheral change, coronal features of ABUS, and structural distortion, asymmetry, and calcification in MG. ABUS is superior to MG and HHUS in sensitivity, specificity, PPV, NPV, as well as in evaluating the necessity of biopsy and accuracy in identifying malignancy. MG was superior to HHUS in specificity, PPV, and accuracy in evaluating the need for biopsy.

CONCLUSIONS

ABUS was superior to HHUS and MG in evaluating the need for biopsy in breast NMLs. Compared to each other, HHUS and MG had their own relative advantages. Internal blood flow, calcification, and coronal plane feature was independent risk factors in NMLs Management, and different screening methods had their own advantages in NML management. The lexicon of ACR BI-RADS could be used not only in the evaluation of mass lesions, but also in the evaluation of NML.