The benefits of contrast-enhanced ultrasound in the differential diagnosis of suspicious breast lesions

Abstract

Background: Contrast-enhanced ultrasound (CEUS) shows potential for the differential diagnosis of breast lesions in general, but its effectiveness remains unclear for the differential diagnosis of lesions highly suspicious for breast cancers.

Objective: This study aimed to evaluate the diagnostic value of CEUS in differentiating pathological subtypes of suspicious breast lesions defined as category 4 of US-BI-RADS.

Methods: The dataset of 150 breast lesions was prospectively collected from 150 patients who underwent routine ultrasound and CEUS examination and were highly suspected of having breast cancers. All lesions were pathologically confirmed by US-guided needle biopsy and surgery. The qualitative features and the quantitative parameters of CEUS of these breast lesions were analyzed. The CEUS and biopsy examinations were performed after informed consent.

Results: In the qualitative features, crab clam-like enhancement, the presence of more than two enhanced vessels within lesions, and surrounding enriched vessels inserting into lesions were able to differentiate atypical fibroadenomas (FIB) and mass-like non-puerperal mastitis (NPM) from invasive ductal carcinomas (IDC) and ductal carcinomas in situ (DCIS) (p < 0.05). The enlarged scope, irregular shape, and perfusion deficiency were valuable to the differential diagnosis of FIB from the others (p < 0.05). In the four quantitative parameters of CEUS, only the peak intensity (IMAX) contributed to the differential diagnosis between malignant and benign tumors (p < 0.05, ROCAUC: 0.61, sensitivity: 60.4% and specificity: 65.9%, accuracy: 62.1%). However, IMAX did not show any difference in the paired comparison of IDC, DCIS, FIB, and NPM (p > 0.05). The logistic regression analysis results showed that heterogeneous perfusion, crab clam-like enhancement, and partial_ IMAX were independent risk factors for benign and malignant breast lesions (p < 0.05). The area under a receiver operating characteristic of the integrated model was 0.89. In the diagnosis of benign and malignant pathological subtypes of breast lesions, independent risk factors and integrated models had no statistical significance in the diagnosis of IDC and DCISs, FIB, and NPM (p > 0.05).

Conclusion: Some qualitative risk features of CEUS can distinguish malignant breast lesions from NPM and atypical FIB with a high score of US-BI-RADS, aiding physicians to reduce the misdiagnosis of suspicious breast lesions in clinical practice.

Keywords: contrast-enhanced ultrasound; differential diagnosis; qualitative features; quantitative parameter; suspicious breast lesions.

Figure 1

Flowchart of patients with breast lesions recruited in this prospective study.

Figure 2

Comparison of the qualitative features risk features of CUES among four histopathological subtypes of breast lesions. (A) Proportion of the qualitative risk features. (B) p-values of the paired comparisons of four histopathological subtypes. IDC, invasive ductal carcinoma; DCIS, ductal carcinoma in site; FIB, fibroadenoma; NPM, non-puerperal mastitis.

Figure 3

Representative US and CEUS images for invasive ductal cancer (IDC) and fibroadenoma. (A) A 65-year-old woman suffering from IDC. The irregular shape and partially unclear margin in the US image (left). The corresponding CEUS image shows surrounding enriched vessels inserting into the lesion, clam-like enhancement, and more than two numbers of enhanced vessels within the lesion (right). (B) A 56-year-old woman suffering from fibroadenoma. Regular shape and a partially unclear margin in the US image (left). The corresponding CEUS image shows surrounding enriched vessels paralleled to the lesion and <2 numbers of enhanced vessels within the lesion.

Figure 4

ROC curve of contrast-enhanced ultrasound diagnosis of suspicious breast lesions.