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Comparative Study
. 2020 Aug;93(1112):20200195.
doi: 10.1259/bjr.20200195. Epub 2020 Jun 2.

Does contrast-enhanced ultrasound (CEUS) play a better role in diagnosis of breast lesions with calcification? A comparison with MRI

Jiamin Pan  1 , Wenjuan Tong  1 , Jia Luo  1 , Jinyu Liang  1 , Fushun Pan  1 , Yanling Zheng  1 , Xiaoyan Xie  1
Affiliations
Comparative Study

Does contrast-enhanced ultrasound (CEUS) play a better role in diagnosis of breast lesions with calcification? A comparison with MRI

Jiamin Pan et al. Br J Radiol. 2020 Aug.

Abstract

Objective: To compare the efficacy of contrast-enhanced ultrasound enabled reclassification of Breast Imaging Reporting and Data System (CEUS-BI-RADS) with MRI in the diagnosis of breast lesions with calcification.

Methods: A total of 52 breast lesions with calcification from 51 patients were detected by ultrasound as hyperechoic foci and categorized as BI-RADS 3-5. The 51 patients further underwent CEUS scan and MRI. The ultrasound-BI-RADS combined with CEUS 5-point score system redefined the classification of BI-RADS which was called CEUS-BI-RADS. The diagnostic efficacy of three methods was assessed by receiver operating characteristic (ROC) curve analysis. Histopathological assessment used as the gold-standard.

Results: The sensitivities of Ultrasound-BI-RADS, MRI classification of BI-RADS (MRI-BI-RADS) and CEUS-BI-RADS were 85%, 90% and 95% without significant difference among the three modalities (p > 0.05). The diagnostic specificities of ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS were 78.1%, 78.1% and 96.8%, respectively (p < 0.05); and the accuracy were 80.7%, 82.6% and 96.1% for ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS, respectively (p < 0.05). The area under ROC (AUROC) in differentiation of breast lesions with calcification was 0.945 for CEUS-BI-RADS, 0.907 for MRI-BI-RADS and 0.853 for ultrasound-BI-RADS, with no significant difference among the three modalities (p > 0.05).

Conclusion: The CEUS-BI-RADS has a better diagnostic efficiency than MRI-BI-RADS in the differentiation of the breast lesions with calcification.

Advances in knowledge: •CEUS is a better method in differentiation of breast lesions with calcification.•CEUS-BI-RADS increases the efficiency of diagnosis compared to MRI.

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Figures

Figure 1.
Figure 1.
A 45-years-old female with an invasive ductal carcinoma, diffuse spotty breast calcifications in the right side. (a/b) Ultrasound scans of the breast lesion categorized as ultrasound-BI-RADS 4A. (c) On CEUS dual image mode, lesion was reclassified as CEUS-BI-RADS 4B. (d) The lesion was categorized as MRI-BI-RADS 4B, all pointing to a malignant lesion. (lesion marked with‘↑’, area of CEUS enhancement was marked with white‘▲’). CEUS-BI-RADS, contrast-enhanced ultrasound reclassification of Breast Imaging Reporting and Data System.
Figure 2.
Figure 2.
A 33-years-old female with breast usual ductal hyperplasia, found breast lesion in the right side for 1 month after bilateral ovarian cancer resection. (a/b) Ultrasound scans of the breast lesion categorized as ultrasound-BI-RADS 4B. (c) On CEUS dual image mode, the lesion was reclassified as CEUS-BI-RADS 3. (d) The lesion was categorized as MRI-BI-RADS 4B by MRI. Both of ultrasound and MRI pointed to a malignant lesion. (lesion marked with‘↑’, area of CEUS enhancement was marked with white‘▲’). CEUS-BI-RADS, contrast-enhanced ultrasound reclassification of Breast Imaging Reporting and Data System.
Figure 3.
Figure 3.
ROC curves representing the diagnostic efficacy of ultrasound-BI-RADS, CEUS-BI-RADS and MRI-BI-RADS for all of 52 breast lesions with calcification. The areas under the receiver operating characteristic curve for ultrasound-BI-RADS, CEUS-BI-RADS and MRI-BI-RADS were 0.853, 0.945 and 0.907, respectively.. CEUS-BI-RADS, contrast-enhanced ultrasound reclassification of Breast Imaging Reporting and Data System.
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