The diagnostic value of real-time ultrasound elastography and contrast-enhanced ultrasound in BI-RADS 4A breast lesions

Abstract

Background: The Breast Imaging-Reporting and Data System (BI-RADS) is the primary system for classifying clinical breast lesions. Most early lesions identified via ultrasound are classified as BI-RADS 4A or lower. Although the vast majority of BI-RADS 4A lesions are benign, those lesions still have the possibility of malignancy in clinical practice, which is a controversial and noteworthy issue. This study aimed to assess the diagnostic value of real-time ultrasound elastography (UE) and contrast-enhanced ultrasound (CEUS) in evaluating BI-RADS 4A breast lesions.

Methods: A retrospective analysis was conducted of the UE and CEUS data of 52 BI-RADS 4A breast lesions from 52 patients between January 2020 and March 2023. All diagnoses were confirmed by surgical pathology. Lesion characteristics, including the margins, echogenicity, size, microcalcifications, blood flow patterns, UE scores, and CEUS features, were analyzed. CEUS scores were based on a five-point system, and the area under the curve (AUC) was calculated using MedCalc version 19.0.4.

Results: Based on the postoperative pathology, of the 52 lesions, 27 were benign and 25 were malignant. Compared to those with benign lesions, the patients with malignant lesions were older and had larger lesions (P<0.05). Features such as irregular morphology, indistinct margins, increased blood flow, and calcifications were more common in the malignant lesions than the benign lesions (P<0.05). The malignant lesions also had a higher prevalence of inhomogeneous enhancement, vasa vasorum, irregular enhanced morphology, and crab claw-like signs on CEUS than the benign lesions (P<0.05). The diagnostic accuracy of both the UE and CEUS individually was 76.9%, while the diagnostic accuracy of the UE and CEUS combined reached 80.8%. The AUCs of UE, CEUS, and the UE and CEUS combined were 0.761, 0.773, and 0.813, respectively.

Conclusions: UE and CEUS have significant diagnostic value for BI-RADS 4A breast lesions. Combining these techniques improves diagnostic accuracy and can help reduce unnecessary biopsies.

Keywords: Breast Imaging-Reporting and Data System 4A (BI-RADS 4A); Real-time ultrasound elastography; breast cancer; contrast-enhanced ultrasound (CEUS); diagnosis.

Figure 1

ROC curves of diagnostic efficacy for UE, CEUS, and UE + CEUS. CEUS, contrast-enhanced ultrasound; ROC, receiver operating characteristic; UE, ultrasound elastography.