Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2020; 8(4): 700-712
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.700
Breast non-mass-like lesions on contrast-enhanced ultrasonography: Feature analysis, breast image reporting and data system classification assessment
Ping Xu, Min Yang, Yong Liu, Yan-Ping Li, Hong Zhang, Guang-Rui Shao
Ping Xu, School of Medicine, Shandong University, Jinan 250100, Shandong Province, China
Ping Xu, Min Yang, Yong Liu, Hong Zhang, Department of Ultrasound, Beijing Shijitan Hospital affiliated to Capital Medical University, Beijing 100038, China
Yan-Ping Li, Department of Breast Surgery, Beijing Shijitan Hospital affiliated to Capital Medical University, Beijing 100038, China
Guang-Rui Shao, Department of Radiology, The Second Hospital of Shandong University, Jinan 250100, Shandong Province, China
Author contributions: All authors helped to perform the research; Xu P and Yang M contributed equally to this paper; Xu P and Yang M contributed to manuscript writing, performing ultrasound examinations, and data analysis; Shao GR contributed to manuscript writing of the manuscript, and conception and design of the study; Liu Y and Li YP contributed to writing of the manuscript, and conception and design of the study; Zhang H contributed to performing the ultrasound examinations.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Beijing Shijitan Hospital Affiliated to Capital Medical University.
Informed consent statement: All patients were informed of the purpose and risk of the examination and signed informed consent prior to contrast-enhanced ultrasonography and ultrasonic guidance breast biopsy.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Guang-Rui Shao, PhD, Chief Doctor, Department Director, Department of Radiology, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan 250100, Shandong Province, China. grshao6088@163.com
Received: November 25, 2019
Peer-review started: November 25, 2019
First decision: December 27, 2019
Revised: December 27, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: February 26, 2020
Abstract
BACKGROUND

Breast non-mass-like lesions (NMLs) account for 9.2% of all breast lesions. The specificity of the ultrasound diagnosis of NMLs is low, and it cannot be objectively classified according to the 5th Edition of the Breast Imaging Reporting and Data System (BI-RADS). Contrast-enhanced ultrasound (CEUS) can help to differentiate and classify breast lesions but there are few studies on NMLs alone.

AIM

To analyze the features of benign and malignant breast NMLs in grayscale ultrasonography (US), color Doppler flow imaging (CDFI) and CEUS, and to explore the efficacy of the combined diagnosis of NMLs and the effect of CEUS on the BI-RADS classification of NMLs.

METHODS

A total of 51 breast NMLs verified by pathology were analyzed in our hospital from January 2017 to April 2019. All lesions were examined by US, CDFI and CEUS, and their features from those examinations were analyzed. With pathology as the gold standard, binary logic regression was used to analyze the independent risk factors for malignant breast NMLs, and a regression equation was established to calculate the efficiency of combined diagnosis. Based on the regression equation, the combined diagnostic efficiency of US combined with CEUS (US + CEUS) was determined. The initial BI-RADS-US classification of NMLs was adjusted according to the independent risk factors identified by CEUS, and the diagnostic efficiency of CEUS combined with BI-RADS (CEUS + BI-RADS) was calculated based on the results. ROC curves were drawn to compare the diagnostic values of the three methods, including US, US + CEUS, and CEUS + BI-RADS, for benign and malignant NMLs.

RESULTS

Microcalcification, enhancement time, enhancement intensity, lesion scope, and peripheral blood vessels were significantly different between benign and malignant NMLs. Among these features, microcalcification, higher enhancement, and lesion scope were identified as independent risk factors for malignant breast NMLs. When US, US + CEUS, and CEUS + BI-RADS were used to identify the benign and malignant breast NMLs, their sensitivity rates were 82.6%, 91.3%, and 87.0%, respectively; their specificity rates were 71.4%, 89.2%, and 92.9%, respectively; their positive predictive values were 70.4%, 87.5%, and 90.9%, respectively; their negative predictive values were 83.3%, 92.6%, and 89.7%, respectively; their accuracy rates were 76.5%, 90.2%, and 90.2%, respectively; and their corresponding areas under ROC curves were 0.752, 0.877 and 0.903, respectively. Z tests showed that the area under the ROC curve of US was statistically smaller than that of US + CEUS and CEUS + BI-RADS, and there was no statistical difference between US + CEUS and CEUS + BI-RADS.

CONCLUSION

US combined with CEUS can improve diagnostic efficiency for NMLs. The adjustment of the BI-RADS classification according to the features of contrast-enhanced US of NMLs enables the diagnostic results to be simple and intuitive, facilitates the management of NMLs, and effectively reduces the incidence of unnecessary biopsy.

Keywords: Breast tumor, Ultrasonography, Contrast agents, Feature exploration, Diagnosis, Non-mass-like lesions

Core tip: Conventional ultrasound diagnosis of non-mass-like lesions in the breast has low specificity, and non-mass-like lesions cannot be classified according to the fifth edition of Breast Imaging Reporting and Data System published by the American College of Radiology. This study aimed to improve the diagnostic efficacy by contrast-enhanced ultrasound and conventional ultrasound, and to explore the effect of contrast-enhanced ultrasound on the classification of non-mass-like lesions in the Breast Imaging Reporting and Data System.