Clinical Trials Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2016; 8(6): 610-617
Published online Jun 28, 2016. doi: 10.4329/wjr.v8.i6.610
Contrast-enhanced ultrasound improved performance of breast imaging reporting and data system evaluation of critical breast lesions
Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Yi Li, Chi-Hua Wu, Jing-Qiao Lu
Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
Yi Li, Chi-Hua Wu, Department of Breast Surgery, Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
Jing-Qiao Lu, Department of Otolaryngology, School of Medicine, Emory University, Atlanta, GA 30322, United States
Author contributions: Luo J designed the research; Luo J, Chen JD, Chen Q, Yue LX, Zhou G, Lan C, LI Y and Wu CH performed the research; Lu JQ analyzed the data; Luo J wrote the paper.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Sichuan Provincial People’s Hospital.
Clinical trial registration statement: This registration policy only applies to a prospective study.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None declared.
Data sharing statement: No data were created so no data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qing Chen, BM, Department of Ultrasound, Sichuan Provincial People’s Hospital, No. 32 First Ring Road, Chengdu 610072, Sichuan Province, China. 1718686103@qq.com
Telephone: +86-28-87394616 Fax: +86-28-87394616
Received: November 18, 2015
Peer-review started: November 19, 2015
First decision: February 2, 2016
Revised: February 27, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: June 28, 2016
Processing time: 213 Days and 19.3 Hours
Abstract

AIM: To determine whether contrast-enhanced ultrasound (CEUS) can improve the precision of breast imaging reporting and data system (BI-RADS) categorization.

METHODS: A total of 230 patients with 235 solid breast lesions classified as BI-RADS 4 on conventional ultrasound were evaluated. CEUS was performed within one week before core needle biopsy or surgical resection and a revised BI-RADS classification was assigned based on 10 CEUS imaging characteristics. Receiver operating characteristic curve analysis was then conducted to evaluate the diagnostic performance of CEUS-based BI-RADS assignment with pathological examination as reference criteria.

RESULTS: The CEUS-based BI-RADS evaluation classified 116/235 (49.36%) lesions into category 3, 20 (8.51%), 13 (5.53%) and 12 (5.11%) lesions into categories 4A, 4B and 4C, respectively, and 74 (31.49%) into category 5. Selecting CEUS-based BI-RADS category 4A as an appropriate cut-off gave sensitivity and specificity values of 85.4% and 87.8%, respectively, for the diagnosis of malignant disease. The cancer-to-biopsy yield was 73.11% with CEUS-based BI-RADS 4A selected as the biopsy threshold compared with 40.85% otherwise, while the biopsy rate was only 42.13% compared with 100% otherwise. Overall, only 4.68% of invasive cancers were misdiagnosed.

CONCLUSION: This pilot study suggests that evaluation of BI-RADS 4 breast lesions with CEUS results in reduced biopsy rates and increased cancer-to-biopsy yields.

Keywords: Breast imaging reporting and data system; Contrast-enhanced ultrasound; Biopsy; False positive biopsy

Core tip: Many published studies show that overdiagnosis is now a problem faced if the breast imaging reporting and data system (BI-RADS) category is used in clinical practice. Many patients underwent unnecessary biopsies even if the final pathological results were benign lesions. It seems that BI-RADS is not good enough and one of the reasons may be that there is no microvascular information. Contrast-enhanced ultrasound (CEUS) can give us this information. We tried to determine whether CEUS can improve the precision of the BI-RADS categorization. Our results showed that in all BI-RADS 4 lesions which were suggested as needing a biopsy, CEUS-based BI-RADS can decrease false positive biopsies and increase cancer-to-biopsy yield and that only 4.68% invasive cancers were misdiagnosed.