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. 2024 Jul 3:12:e17677.
doi: 10.7717/peerj.17677. eCollection 2024.

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

Yan Shen #  1 , Jie He #  1 , Miao Liu  1 , Jiaojiao Hu  1 , Yonglin Wan  1 , Tingting Zhang  1 , Jun Ding  2 , Jiangnan Dong  3 , Xiaohong Fu  1
Affiliations

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

Yan Shen et al. PeerJ. .

Abstract

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.

Keywords: BI-RADS classification; Contrast-enhanced ultrasound; Shear-wave elastography; Small breast nodule; Ultrasound.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Flowchart of patient selection.
Figure 2
Figure 2. (A) An irregular and uncircumscribed nodule classified as BI-RADS 4A. (B) CEUS revealed no significant enhancement, and the volume decreased after enhancement. (C) The average SWV on SWE was 2.8 m/s, which was below the cutoff, indicating that the texture of the nodules was soft. After combining BI-RADS, CEUS, and SWE, the BI-RADS category was downgraded to BI-RADS 3. The final pathological result was breast adenopathy. (D) The nodule was not circumscribed and not parallel, and it was classified as BI-RADS 4A. (E) CEUS displayed high enhancement and an increased volume after enhancement. (F) The average SWV on SWE was 4.1 m/s, which exceeded the cutoff, indicating that the nodule was hard.
After combining BI-RADS, CEUS, and SWE, the BI-RADS category was upgraded to BI-RADS 4B. The final pathological result was ductal carcinoma in situ. BI-RADS, Breast Imaging Reporting, and Data System; SWV, shear-wave velocity; SWE, shear-wave elastography; CEUS, contrast-enhanced ultrasound.
Figure 3
Figure 3. Analysis of the receiver operating characteristic curves of the four methods.
See this image and copyright information in PMC

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