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. 2024 Feb 12;26(1):27.
doi: 10.1186/s13058-024-01772-2.

Contrast-enhanced ultrasound to predict malignant upgrading of atypical ductal hyperplasia

Jun Kang Li #  1   2 , Zhi Ying Jin #  1 , Yong Jie Xu  3 , Nai Qin Fu  1 , Ying Jiang  1 , Shi Yu Li  1 , Rui Lan Niu  1 , Gang Liu  4 , Zhi Li Wang  5
Affiliations

Contrast-enhanced ultrasound to predict malignant upgrading of atypical ductal hyperplasia

Jun Kang Li et al. Breast Cancer Res. .

Abstract

Background: A malignancy might be found at surgery in cases of atypical ductal hyperplasia (ADH) diagnosed via US-guided core needle biopsy (CNB). The objective of this study was to investigate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in predicting ADH diagnosed by US-guided CNB that was upgraded to malignancy after surgery.

Methods: In this retrospective study, 110 CNB-diagnosed ADH lesions in 109 consecutive women who underwent US, CEUS, and surgery between June 2018 and June 2023 were included. CEUS was incorporated into US BI-RADS and yielded a CEUS-adjusted BI-RADS. The diagnostic performance of US BI-RADS and CEUS-adjusted BI-RADS for ADH were analyzed and compared.

Results: The mean age of the 109 women was 49.7 years ± 11.6 (SD). The upgrade rate of ADH at CNB was 48.2% (53 of 110). The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS for identification of malignant upgrading were 96.2%, 66.7%,72.9%, and 95.0%, respectively, based on BI-RADS category 4B threshold. The two false-negative cases were low-grade ductal carcinoma in situ. Compared with the US, CEUS-adjusted BI-RADS had better specificity for lesions smaller than 2 cm (76.7% vs. 96.7%, P = 0.031). After CEUS, 16 (10 malignant and 6 nonmalignant) of the 45 original US BI-RADS category 4A lesions were up-classified to BI-RADS 4B, and 3 (1 malignant and 2 nonmalignant) of the 41 original US BI-RADS category 4B lesions were down-classified to BI-RADS 4A.

Conclusions: CEUS is helpful in predicting malignant upgrading of ADH, especially for lesions smaller than 2 cm and those classified as BI-RADS 4A and 4B on ultrasound.

Keywords: Atypical ductal hyperplasia; Biopsy; Contrast media; Ultrasound.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Flowchart of the process of patient enrollment
Fig. 2
Fig. 2
Image of a 30-year-old woman with a palpable mass. a B-mode ultrasound image; b contrast-enhanced ultrasound image showed that the lesion displayed iso-enhancement with the surrounding tissue. The CEUS score was 2 points. This lesion was originally classified as US BI-RADS 4A, downgraded to BI-RADS 3 after CEUS, and diagnosed as atypical ductal hyperplasia via US-guided core needle biopsy and as adenosis at surgery
Fig. 3
Fig. 3
Image of a 42-year-old woman with a nonpalpable mass. a B-mode ultrasound image; b contrast-enhanced ultrasound image showed that the lesion displayed hyper-enhancement with ill-defined enhancement margin, enlarged size on CEUS, and penetrating vessels. The CEUS score was 5 points. This lesion was originally classified as US BI-RADS 4A, upgraded to BI-RADS 4B after CEUS, and diagnosed as atypical ductal hyperplasia via US-guided core needle biopsy and as ductal carcinoma in situ at surgery
Fig. 4
Fig. 4
Image of a 60-year-old woman with a palpable mass. a B-mode ultrasound image; b contrast-enhanced ultrasound image showed that the lesion displayed iso-enhancement with the surrounding tissue. The CEUS score was 2 points. This lesion was originally classified as US BI-RADS 4B, downgraded to BI-RADS 4A after CEUS, and diagnosed as atypical ductal hyperplasia via US-guided core needle biopsy and as ductal carcinoma in situ at surgery
Fig. 5
Fig. 5
Image of a 38-year-old woman with a nonpalpable mass. a B-mode ultrasound image; b contrast-enhanced ultrasound image showed that the lesion displayed hyper-enhancement with ill-defined enhancement margin and enlarged size on CEUS. The CEUS score was 4 points. This lesion was originally classified as US BI-RADS 4C, upgraded to BI-RADS 5 after CEUS, and both were diagnosed as atypical ductal hyperplasia at US-guided core needle biopsy and at surgery
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