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Dai X, Zhou XY, Chen PF, Gong ZL, Wang ZP, Wang D. The Application Value of Using Semiquantitative and Quantitative Parameters in Multimodal Ultrasound to Distinguish Between Benign and Malignant BI-RADS 4 Lesions. Ultrasound Q 2024; 40:e00686. [PMID: 39105688 DOI: 10.1097/ruq.0000000000000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
ABSTRACT This study aims to explore the value of real-time strain elastography (RTE) and contrast-enhanced ultrasonography (CEUS) in the diagnosis of breast BI-RADS 4 lesions. It collected 85 cases (totaling 85 lesions) diagnosed with breast BI-RADS 4 through routine ultrasound from October 2020 to December 2022 in Huangshan City People's Hospital. All lesions underwent RTE and CEUS examination before surgery, and the ImageJ software was used to measure the periphery of lesion images in the enhancement peak mode and grayscale mode to calculate the contrast-enhanced ultrasound area ratio. The diagnostic capabilities of single-modal and multimodal ultrasound examination for the malignancy of breast BI-RADS 4 lesions were compared using the receiver operating characteristic curve; the Spearman correlation analysis was adopted to evaluate the correlation between multimodal ultrasound and CEUS area ratio. As a result, among the 85 lesions, 51 were benign, and 34 were malignant. The areas under the curve (AUCs) of routine ultrasound (US), US + RTE, US + CEUS, and US + RTE + CEUS were 0.816, 0.928, 0.953, and 0.967, respectively, with the combined method showing a higher AUC than the single application. The AUC of the CEUS area ratio diagnosing breast lesions was 0.888. There was a strong positive correlation (r = 0.819, P < 0.001) between the diagnostic performance of US + RTE + CEUS and the CEUS area ratio. In conclusion, based on routine ultrasound, the combination of RTE and CEUS can further improve the differential diagnosis of benign and malignant lesions in breast BI-RADS 4.
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Affiliation(s)
- Xi Dai
- Department of Ultrasound, Huangshan City People's Hospital, Huangshan, China
| | - Xiao-Yu Zhou
- Department of Ultrasound, Huangshan City People's Hospital, Huangshan, China
| | - Piao-Fei Chen
- Department of Ultrasound, Huangshan City People's Hospital, Huangshan, China
| | - Zhe-Li Gong
- Department of Ultrasound, Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Zhi-Ping Wang
- Department of Ultrasound, Huangshan City People's Hospital, Huangshan, China
| | - Di Wang
- Department of Pathology, Huangshan City People's Hospital, Huangshan, China
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Li H, Cong P, Yu YN, Zhang YF. Value of sonoelastography for diagnosis of breast non-mass lesions and comparison with BI-RADS: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38425. [PMID: 38847732 PMCID: PMC11155584 DOI: 10.1097/md.0000000000038425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Not all the breast lesions were mass-like, some were non-mass-like at ultrasonography. In these lesions, conventional ultrasonography had a high sensitivity but a low specificity. Sonoelastography can evaluate tissue stiffness to differentiate malignant masses from benign ones. Then what about the non-mass lesions? The aim of this study was to evaluate the current accuracy of sonoelastography in the breast non-mass lesions and compare the results with those of the American College of Radiology breast Imaging-Reporting and Data System (BI-RADS). METHODS An independent literature search of English medical databases, including PubMed, Web of Science, Embase & MEDLINE (Embase.com) and Cochrane Library, was performed by 2 researchers. The accuracy of sonoelastography was calculated and compared with those of BI-RADS. RESULTS Fourteen relevant studies including 1058 breast non-mass lesions were included. Sonoelastography showed a pooled sensitivity of 0.74 (95% CI: 0.70-0.78), specificity of 0.89 (95% CI: 0.85-0.91), diagnostic odds ratio (DOR) of 25.22 (95% CI: 17.71-35.92), and an area under the curve of 0.9042. Eight articles included both sonoelastography and BI-RADS. The pooled sensitivity, specificity, DOR and AUC were 0.69 versus 0.91 (P < .01), 0.90 versus 0.68 (P < .01), 19.65 versus 29.34 (P > .05), and 0.8685 versus 0.9327 (P > .05), respectively. CONCLUSIONS Sonoelastography has a higher specificity and a lower sensitivity for differential diagnosis between malignant and benign breast non-mass lesions compared with BI-RADS, although there were no differences in AUC between them.
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Affiliation(s)
- Hong Li
- Department of Transplantation and General Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Peng Cong
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Ya-Na Yu
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Yun-Fei Zhang
- Department of Ultrasound, The First Hospital of China Medical University, Shenyang, China
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Fu N, Li J, Wang B, Jiang Y, Li S, Niu R, Wang Z. Diagnostic performance of contrast-enhanced ultrasound in breast lesions: what diagnostic models could be used for lesions of different sizes? Gland Surg 2023; 12:1654-1667. [PMID: 38229844 PMCID: PMC10788570 DOI: 10.21037/gs-23-223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/17/2023] [Indexed: 01/18/2024]
Abstract
Background Previous studies show the size of lesions could affect the diagnostic accuracy of contrast-enhanced ultrasound (CEUS). It is unclear whether CEUS has good diagnostic performance for lesions ≤2.0 and ≤1.0 cm. It is beneficial for the early diagnosis to explore the application of CEUS in breast lesions of different sizes. This study aims to analyze the diagnostic performance of CEUS and explore diagnostic models better suited to breast lesions of different sizes. Methods A total of 1,059 lesions (656 benign and 403 malignant) examined by ultrasound and CEUS with definite pathological results were included in this retrospective study and divided into training (n=847) and validation (n=212) sets. All lesions were divided into three groups according to size. Diagnostic models (M0: all lesions; M1: ≤1.0 cm, M2: >1.0-2.0 cm, and M3: >2.0 cm) were developed through logistic regression analyses of CEUS features from the training set. Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC) and validated in the validation set. Results The median age of patients was 45±11 years (range, 18-80 years). The AUC values of M0 combined with the Breast Imaging Reporting and Data System (BI-RADS) in the training and validation sets were 0.921 and 0.922, respectively (P=0.893). The AUC values of M0 combined with BI-RADS in the three groups were 0.844, 0.936 and 0.928 respectively. M0 was less effective in diagnosing lesions ≤1.0 cm (0.844 vs. 0.921, P=0.029). The AUC of M1 combined with BI-RADS for lesions ≤1.0 cm was higher than that of M0 (0.893 vs. 0.844, P=0.047), and M2 and M3 had no statistical difference in diagnostic performance when compared with M0 (P=0.243; P=0.246). Conclusions The diagnostic performance of CEUS was closely related to lesion size. Establishing a new diagnostic model for lesions ≤1.0 cm can improve the CEUS diagnostic performance for breast lesions ≤1.0 cm.
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Affiliation(s)
- Naiqin Fu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Junkang Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- Department of Ultrasound, Chinese PLA 63820 Hospital, Mianyang, China
| | - Bo Wang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Jiang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shiyu Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ruilan Niu
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhili Wang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Chen X, Yu H, Wei N, Ozcan BB, An G, Wu Q, Wang N. Diagnostic performance of contrast-enhanced ultrasound combined with shear wave elastography in differentiating benign from malignant breast lesions: a systematic review and meta-analysis. Gland Surg 2023; 12:1610-1623. [PMID: 38107493 PMCID: PMC10721556 DOI: 10.21037/gs-23-333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/27/2023] [Indexed: 12/19/2023]
Abstract
Background The value of contrast-enhanced ultrasound (CEUS), shear wave elastography (SWE) and their combination in the diagnosis of benign and malignant breast lesions have not been systematically evaluated. This study aimed to evaluate the diagnostic value of CEUS combined with SWE in benign and malignant breast lesions. Methods We searched six electronic databases for literature to evaluate the value of CEUS combined with SWE in the diagnosis of benign and malignant breast lesions from inception to May 2023. Review Manager 5.4 (Cochrane), Meta-DiSc 1.4, and Stata 14.0 (StataCorp) were used for meta-analysis. The pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC) were calculated to evaluate the diagnostic performance. Results Ultimately, 17 studies were analyzed including 1,962 lesions in total. The overall quality of the included literature was acceptable, and no significant publication bias was found among the included studies. The pooled diagnostic performance measures for CEUS were as follows: SEN: 0.86 [95% confidence interval (CI): 0.84-0.88], SPE: 0.78 (95% CI: 0.75-0.80), PLR: 4.10 (95% CI: 2.86-5.90), NLR: 0.20 (95% CI: 0.15-0.25), DOR: 23.68 (95% CI: 16.77-33.44), and AUC: 0.90 (95% CI: 0.87-0.93); while, for SWE, SEN: 0.83 (95% CI: 0.81-0.86), SPE: 0.81 (95% CI: 0.78-0.83), PLR: 4.36 (95% CI: 3.18-5.97), NLR: 0.22 (95% CI: 0.17-0.29), DOR: 23.13 (95% CI: 14.70-36.40), and AUC: 0.90 (95% CI: 0.87-0.92). The measures for the pooled diagnostic performance of CEUS combined with SWE were as follows: SEN: 0.92 (95% CI: 0.90-0.94), SPE: 0.87 (95% CI: 0.85-0.89), PLR: 7.10 (95% CI: 5.24-9.61), NLR: 0.11 (95% CI: 0.07-0.16), DOR: 83.51 (95% CI: 49.67-140.39), and AUC: 0.96 (95% CI: 0.94-0.98). There was no statistically significant difference in SEN, SPE, and accuracy (ACC) between CEUS and SWE (P>0.05), but they were significantly lower than those of CEUS combined with SWE (P<0.001). Conclusions The diagnostic performance of CEUS combined with SWE is higher than that of using CEUS or SWE alone and can further improve the diagnosis of breast lesions.
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Affiliation(s)
- Xinyu Chen
- Department of Ultrasound, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Hairong Yu
- Department of Ultrasound, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Na Wei
- Department of Ultrasound, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Berat Bersu Ozcan
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Guifang An
- Department of Ultrasound, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Qiong Wu
- Department of Ultrasound, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Ning Wang
- Department of Ultrasound, Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, China
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Li Y, Wei XL, Pang KK, Ni PJ, Wu M, Xiao J, Zhang LL, Zhang FX. A comparative study on the features of breast sclerosing adenosis and invasive ductal carcinoma via ultrasound and establishment of a predictive nomogram. Front Oncol 2023; 13:1276524. [PMID: 37936612 PMCID: PMC10627161 DOI: 10.3389/fonc.2023.1276524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To analyze the clinical and ultrasonic characteristics of breast sclerosing adenosis (SA) and invasive ductal carcinoma (IDC), and construct a predictive nomogram for SA. Materials and methods A total of 865 patients were recruited at the Second Hospital of Shandong University from January 2016 to November 2022. All patients underwent routine breast ultrasound examinations before surgery, and the diagnosis was confirmed by histopathological examination following the operation. Ultrasonic features were recorded using the Breast Imaging Data and Reporting System (BI-RADS). Of the 865 patients, 203 (252 nodules) were diagnosed as SA and 662 (731 nodules) as IDC. They were randomly divided into a training set and a validation set at a ratio of 6:4. Lastly, the difference in clinical characteristics and ultrasonic features were comparatively analyzed. Result There was a statistically significant difference in multiple clinical and ultrasonic features between SA and IDC (P<0.05). As age and lesion size increased, the probability of SA significantly decreased, with a cut-off value of 36 years old and 10 mm, respectively. In the logistic regression analysis of the training set, age, nodule size, menopausal status, clinical symptoms, palpability of lesions, margins, internal echo, color Doppler flow imaging (CDFI) grading, and resistance index (RI) were statistically significant (P<0.05). These indicators were included in the static and dynamic nomogram model, which showed high predictive performance, calibration and clinical value in both the training and validation sets. Conclusion SA should be suspected in asymptomatic young women, especially those younger than 36 years of age, who present with small-size lesions (especially less than 10 mm) with distinct margins, homogeneous internal echo, and lack of blood supply. The nomogram model can provide a more convenient tool for clinicians.
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Affiliation(s)
- Yuan Li
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiu-liang Wei
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Kun-kun Pang
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Ping-juan Ni
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mei Wu
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Juan Xiao
- Center of Evidence-Based Medicine, Institute of Medical Sciences, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Lu-lu Zhang
- Department of Pathology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Fei-xue Zhang
- Department of Ultrasound, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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