Evaluation of diagnostic efficacy of multimode ultrasound in BI-RADS 4 breast neoplasms and establishment of a predictive model

Utilizing multimodal ultrasonography in conjunction with serum Ki-67 and HER2 tests for breast cancer detection and prognosis

ObjectiveTo examine the diagnostic and prognostic value of multimodal ultrasound and serum human epidermal growth factor receptor 2 (HER2) and Ki-67 antigen (Ki-67) testing for breast cancer.MethodsWe enrolled 65 patients with breast cancer admitted to the Tianjin Fourth Centre Hospital between March 2018 and March 2019 as the study group, while the control group consisted of 65 patients with benign breast nodules admitted during the same time period. All cases underwent ultrasound elastography (UE), contrast-enhanced ultrasonography (CEUS), serum examination, and Ki-67 and HER2 testing to determine the differences in multimodal ultrasound parameters and biomarkers, respectively, between the two groups and their relationship to the pathological features of breast cancer; ROC curves were generated to determine the accuracy of the combined examination in predicting breast cancer prognosis.ResultsThe study group had significantly higher UE score and CEUS-PI, significantly lower time to peak (TTP) and mean transit time (MTT) levels than the control group (P < 0.001), and significantly higher serum HER2 and tumor tissue Ki-67 expression (P < 0.05).ConclusionIt is possible to improve the breast cancer diagnosis rate by using multimodal ultrasound in conjunction with serum Ki-67 and HER2 testing.

Combined use of super-resolution ultrasound imaging and shear-wave elastography for differential diagnosis of breast masses

Objectives

Shear-wave elastography (SWE) provides valuable stiffness within breast masses, making it a useful supplement to conventional ultrasound imaging. Super-resolution ultrasound (SRUS) imaging enhances microvascular visualization, aiding in the differential diagnosis of breast masses. Current clinical ultrasound diagnosis of breast cancer primarily relies on gray-scale ultrasound. The combined diagnostic potential of tissue stiffness and microvascular characteristics, two critical tumor biomarkers, remains insufficiently explored. This study aims to evaluate the correlation between the elastic modulus, assessed using SWE, and microvascular characteristics captured through SRUS, in order to evaluate the effectiveness of combining these techniques in distinguishing between benign and malignant breast masses.

Materials and methods

In this single-center prospective study, 97 patients underwent SWE to obtain parameters including maximum elasticity (Emax), minimum elasticity (Emin), mean elasticity (Emean), standard deviation of elasticity (Esd), and elasticity ratio. SRUS was used to calculate the microvascular flow rate and microvessel density (MVD) within the breast masses. Spearman correlation analysis was used to explore correlations between Emax and MVD. Receiver operating characteristic curves and nomogram were employed to assess the diagnostic efficacy of combining SRUS with SWE, using pathological results as the gold standard.

Results

Emax, Emean, Esd, and MVD were significantly higher in malignant breast masses compared to benign ones (p < 0.001), while Emin was significantly lower in malignant masses (p < 0.05). In Spearman correlation analysis, Emax was significantly positively correlated with MVD (p < 0.01). The area under the curve for SRUS combined with SWE (0.924) was significantly higher than that for SWE (0.883) or SRUS (0.830) alone (p < 0.001), thus indicating improved diagnostic accuracy. The decision curve analysis of the nomogram indicated that SWE combined with SRUS model had a higher net benefit in predicting breast cancer.

Conclusions

The MVD of the breast mass shows a significant positive correlation with Emax. By integrating SRUS with SWE, this study proposes a novel diagnostic approach designed to improve specificity and accuracy in breast cancer detection, surpassing the limitations of current ultrasound-based methods. This approach shows promise for early breast cancer detection, with the potential to reduce the need for unnecessary biopsies and improve patient outcomes.

Diagnostic value of contrast-enhanced ultrasound and shear-wave elastography for small breast nodules

Background

The study aims to evaluate the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE) in detecting small malignant breast nodules in an effort to inform further refinements of the Breast Imaging Reporting and Data System (BI-RADS) classification system.

Methods

This study retrospectively analyzed patients with breast nodules who underwent conventional ultrasound, CEUS, and SWE at Gongli Hospital from November 2015 to December 2019. The inclusion criteria were nodules ≤ 2 cm in diameter with pathological outcomes determined by biopsy, no prior treatments, and solid or predominantly solid nodules. The exclusion criteria included pregnancy or lactation and low-quality images. Imaging features were detailed and classified per BI-RADS. Diagnostic accuracy was assessed using receiver operating characteristic curves.

Results

The study included 302 patients with 305 breast nodules, 113 of which were malignant. The diagnostic accuracy was significantly improved by combining the BI-RADS classification with CEUS and SWE. The combined approach yielded a sensitivity of 88.5%, specificity of 87.0%, positive predictive value of 80.0%, negative predictive value of 92.8%, and accuracy of 87.5% with an area under the curve of 0.877. Notably, 55.8% of BI-RADS 4A nodules were downgraded to BI-RADS 3 and confirmed as benign after pathological examination, suggesting the potential to avoid unnecessary biopsies.

Conclusion

The integrated use of the BI-RADS classification, CEUS, and SWE enhances the accuracy of differentiating benign and malignant small breast nodule, potentially reducing the need for unnecessary biopsies.

Diagnostic performance of contrast-enhanced ultrasound combined with shear wave elastography in differentiating benign from malignant breast lesions: a systematic review and meta-analysis

Background

The value of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE) and their combination in the diagnosis of benign and malignant breast lesions have not been systematically evaluated. This study aimed to evaluate the diagnostic value of CEUS combined with SWE in benign and malignant breast lesions.

Methods

We searched six electronic databases for literature to evaluate the value of CEUS combined with SWE in the diagnosis of benign and malignant breast lesions from inception to May 2023. Review Manager 5.4 (Cochrane), Meta-DiSc 1.4, and Stata 14.0 (StataCorp) were used for meta-analysis. The pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC) were calculated to evaluate the diagnostic performance.

Results

Ultimately, 17 studies were analyzed including 1,962 lesions in total. The overall quality of the included literature was acceptable, and no significant publication bias was found among the included studies. The pooled diagnostic performance measures for CEUS were as follows: SEN: 0.86 [95% confidence interval (CI): 0.84-0.88], SPE: 0.78 (95% CI: 0.75-0.80), PLR: 4.10 (95% CI: 2.86-5.90), NLR: 0.20 (95% CI: 0.15-0.25), DOR: 23.68 (95% CI: 16.77-33.44), and AUC: 0.90 (95% CI: 0.87-0.93); while, for SWE, SEN: 0.83 (95% CI: 0.81-0.86), SPE: 0.81 (95% CI: 0.78-0.83), PLR: 4.36 (95% CI: 3.18-5.97), NLR: 0.22 (95% CI: 0.17-0.29), DOR: 23.13 (95% CI: 14.70-36.40), and AUC: 0.90 (95% CI: 0.87-0.92). The measures for the pooled diagnostic performance of CEUS combined with SWE were as follows: SEN: 0.92 (95% CI: 0.90-0.94), SPE: 0.87 (95% CI: 0.85-0.89), PLR: 7.10 (95% CI: 5.24-9.61), NLR: 0.11 (95% CI: 0.07-0.16), DOR: 83.51 (95% CI: 49.67-140.39), and AUC: 0.96 (95% CI: 0.94-0.98). There was no statistically significant difference in SEN, SPE, and accuracy (ACC) between CEUS and SWE (P>0.05), but they were significantly lower than those of CEUS combined with SWE (P<0.001).

Conclusions

The diagnostic performance of CEUS combined with SWE is higher than that of using CEUS or SWE alone and can further improve the diagnosis of breast lesions.

A comparative study on the features of breast sclerosing adenosis and invasive ductal carcinoma via ultrasound and establishment of a predictive nomogram

Objective

To analyze the clinical and ultrasonic characteristics of breast sclerosing adenosis (SA) and invasive ductal carcinoma (IDC), and construct a predictive nomogram for SA.

Materials and methods

A total of 865 patients were recruited at the Second Hospital of Shandong University from January 2016 to November 2022. All patients underwent routine breast ultrasound examinations before surgery, and the diagnosis was confirmed by histopathological examination following the operation. Ultrasonic features were recorded using the Breast Imaging Data and Reporting System (BI-RADS). Of the 865 patients, 203 (252 nodules) were diagnosed as SA and 662 (731 nodules) as IDC. They were randomly divided into a training set and a validation set at a ratio of 6:4. Lastly, the difference in clinical characteristics and ultrasonic features were comparatively analyzed.

Result

There was a statistically significant difference in multiple clinical and ultrasonic features between SA and IDC (P<0.05). As age and lesion size increased, the probability of SA significantly decreased, with a cut-off value of 36 years old and 10 mm, respectively. In the logistic regression analysis of the training set, age, nodule size, menopausal status, clinical symptoms, palpability of lesions, margins, internal echo, color Doppler flow imaging (CDFI) grading, and resistance index (RI) were statistically significant (P<0.05). These indicators were included in the static and dynamic nomogram model, which showed high predictive performance, calibration and clinical value in both the training and validation sets.

Conclusion

SA should be suspected in asymptomatic young women, especially those younger than 36 years of age, who present with small-size lesions (especially less than 10 mm) with distinct margins, homogeneous internal echo, and lack of blood supply. The nomogram model can provide a more convenient tool for clinicians.