Predictive model for contrast-enhanced ultrasound of the breast: Is it feasible in malignant risk assessment of breast imaging reporting and data system 4 lesions?

Figure 1 Predictive models for contrast-enhanced ultrasound of malignant breast lesions. A: Hyper-enhancement, enlarged size after enhancement, irregular shape, IDC; B: Hyper-enhancement, centripetal enhancement, enlarged size, present perfusion defect (red arrow), IDC; C: Rapid wash-in with hyper-enhancement, present penetrating vessels (black arrow), IDC; D: Rapid wash-in with hyper-enhancement, present crab claw-like pattern (white arrows); IDC; E: Synchronous wash-in with iso-enhancement, with perfusion defect (red arrow), DCIS. IDC: Invasive ductal carcinoma; DCIS: Ductal carcinoma in suit.

Figure 2 Predictive models for contrast-enhanced ultrasound of benign breast lesions. A: Hyper-enhancement, equal size after enhancement, regular shape, without penetrating vessels, adenoma; B: Synchronous wash-in with iso-enhancement, can not distinguish margin and shape after enhancement, without perfusion defect or penetrating vessels, adenosis; C: Slow wash-in with hypo-enhancement, equal size after enhancement, without penetrating vessels, adenosis.

Figure 3 Receiver operating characteristic curve of logistic regression for contrast-enhanced ultrasound patterns. Nine independent variables were identified in the final step of the logistic regression analysis forward model: Enhancement intensity, enhancement time, enhancement direction, internal homogeneity, perfusion defect, crab claw-like pattern, nourishing vessels, margin and scope after enhancement. Area under the curve was 0.911.

Figure 4 Distribution of pathologic results in different breast contrast-enhanced ultrasound malignant predictive models.

Figure 5 Distribution of pathologic results in different breast contrast-enhanced ultrasound benign predictive models.