Clinical Application Of Contrast-enhanced Ultrasound Scoring Method In Breast Tumors

Part I Clinical application of contrast-enhanced ultrasound scoring method in evaluating benign and malignant breast tumorsObjective: Early detection,diagnosis and treatment of breast cancer are the key factors to improve the prognosis and reduce mortality of breast cancer.The purpose of this study is to analyze the diagnostic significance of contrast-enhanced ultrasound(CEUS)qualitative and quantitative indicators in distinguishing benign and malignant breast diseases,and to propose a practical and accurate CEUS diagnosis management strategy.Methods: A retrospective analysis was made on 202 patients with breast masses confirmed by pathology in our hospital from January 2019 to September 2021,including 142 benign lesions and 60 malignant lesions.Conventional ultrasound was classified according to the evaluation criteria of breast imaging report and data system(BI-RADS).The qualitative and quantitative indicators were analyzed by contrastenhanced ultrasound,and the benign and malignant tumors were compared.The qualitative indicators included enhancement intensity,enhancement sequence,enhancement uniformity,enhanced morphology,enhanced border,crab foot sign around the tumor,perforator vessels,enhancement phase and enhancement range.Quantitative indicators include peak intensity(PE),rise time(RT),local average transition time(m TTI),peak to peak time(TTP),fall time(FT),area under the inflow phase curve(Wi AUC),area under the outflow phase curve(Wo AUC),inflow phase ratio(Wi R),outflow phase ratio(Wo R),and total area under the inflow and outflow phase curves(Wi Wo AUC).Logistic regression analysis was performed between qualitative and quantitative indexes of contrast-enhanced ultrasound and malignant tumors.Based on the statistical results,two ultrasound diagnosis management strategies for conventional ultrasound combined with contrast-enhanced ultrasound(CEUS),namely the combined method one(5-point method)and the combined method two(10-point method),were proposed,and the diagnostic efficiency of these two management strategies was compared with that of conventional ultrasound.Results: Among the 9 qualitative indicators,the enhancement order(p-value0.245),enhancement uniformity(p-value 0.633),perforating vessels(p-value 0.668),enhanced morphology(p-value 0.731),and enhanced boundary(p-value 0.812)showed no statistically significant differences between the benign and malignant breast mass groups(p-value<0.05),enhancement intensity(p-value 0.045),enhanced range(pvalue 0.022),and crab foot sign(p-value 0.022)The four indicators of enhanced phase(p-value 0.000)showed statistically significant differences between the benign and malignant breast mass groups(p-value<0.05).Among the 10 quantitative indicators,the peak intensity(PE,p-value 0.034),rise time(RT,p-value 0.024),and fall time(FT,p-value 0.032)showed statistically significant differences between the benign and malignant breast mass groups(p-value<0.05),while the other 7 quantitative indicators showed no statistically significant differences between the benign and malignant breast mass groups(p-value>0.05).In logistic regression analysis,only the independent correlation between enhancement intensity,increased range after enhancement,crab foot sign,enhancement phase,peak intensity(PE),rise time(RT)with the differentiation of benign and malignant breast masses was statistically significant.Based on the results of logistic regression analysis,combined method one(5-point method)and combined method two(10-point method)were proposed for re evaluation and parallel BI-RADS classification of breast tumors.The area under the ROC curve for conventional ultrasound diagnosis of benign and malignant breast tumors was 0.67(95% CI: 0.62-0.78),while the area under the ROC curve for combined method one(5-point method)diagnosis of benign and malignant breast tumors was 0.89(95% CI:0.83-0.94),The area under the ROC curve for diagnosing benign and malignant breast tumors using the combined method two(10 point method)is 0.92(95% CI: 0.88-0.96),and the diagnostic efficiency of the two combined methods is significantly higher than that of conventional ultrasound.The sensitivity of both combined methods for diagnosing benign and malignant breast masses was 88.3%,and the specificity was79.6% and 85.9%,respectively.Conclusion: The combination of conventional ultrasound and contrast-enhanced ultrasound(CEUS)has high diagnostic value in differentiating benign and malignant breast tumors.The ultrasound diagnosis management strategies of combination method one(5-point method)and combination method two(10-point method)are practical and effective,and are worth promoting and using.Part II The diagnostic value of contrast-enhanced ultrasound in breast BIRADS 4a lesions with a diameter of less than 2cmObjective: Breast cancer is the most common malignant tumor in women.Early diagnosis of benign and malignant breast tumors is of great significance,and to evaluate the diagnostic value of combined method one(5 points method)for smaller breast cancer..Methods: A retrospective analysis was conducted on 143 cases of breast masses with a maximum diameter of less than 2cm diagnosed by conventional ultrasound as BI-RADS 4a in our hospital from January 2019 to September 2022,and contrastenhanced ultrasound examination was performed in our hospital.Analyze contrastenhanced ultrasound images and perform BI-RADS reclassification of masses based on the 5-point method proposed in the first part.Using pathological diagnosis as the gold standard,analyze the sensitivity,specificity,positive predictive value,and negative predictive value of conventional ultrasound combined with contrast-enhanced ultrasound in diagnosing benign and malignant tumors,and evaluate the diagnostic value of the combination of the two.Analyze contrast-enhanced ultrasound images and perform BI-RADS reclassification of masses based on the 5-point method proposed in the first part.Using pathological diagnosis as the gold standard,analyze the sensitivity,specificity,positive predictive value,and negative predictive value of conventional ultrasound combined with contrast-enhanced ultrasound in diagnosing benign and malignant tumors,and evaluate the diagnostic value of the combination of the two.Results:(1)143 cases of BI-RADS 4a breast masses with a diameter less than 2cm,including 103 benign and 40 malignant.Among them,73 cases had masses with a maximum diameter of ≤ 1cm.(2)According to the BI-RADS-CEUS classification after contrast-enhanced ultrasound,the sensitivity,specificity,positive predictive value,and negative predictive value of conventional ultrasound combined with contrastenhanced ultrasound for the diagnosis of 143 cases of small breast masses were 0.900,0.864,0.720,and 0.953,respectively.The area under the ROC curve for the diagnosis of small breast masses in the BI-RADS-CEUS classification after CEUS was 0.906(95% CI: 0.848-0.949)(3)The sensitivity,specificity,positive predictive value,and negative predictive value of BI-RADS-CEUS classification for benign and malignant breast masses with a maximum diameter of ≤ 1cm in 73 cases were 0.818,0.839,0.751,and 0.962,respectively.The area under the ROC curve for BI-RADS-CEUS classification for benign and malignant tumors after CEUS was 0.853(95% CI: 0.750-0.925).CONCLUSION: Contrast-enhanced ultrasound can help improve the accuracy of conventional ultrasound diagnosis for benign and malignant breast masses of BIRADS 4a with a maximum diameter of less than 2cm,so as to improve the diagnostic accuracy of early breast cancer and reduce unnecessary invasive treatment such as puncture biopsy.Part III Clinical application of conventional ultrasound and contrast-enhanced ultrasound in benign ductal papillary lesions of the breastObjective: Benign intraductal papilloma of the breast is intraductal papilloma(IDP)with or without atypical hyperplasia,which is considered to have a high probability of malignancy.Clinical treatment opinions are not uniform,and conventional ultrasound is difficult to differentiate some intraductal papilloma(IDP)from breast cancer.This article aims to study the CEUS characteristics of intraductal papilloma(IDP)and explore whether conventional ultrasound combined with CEUS is helpful in the differential diagnosis of breast IDP and malignant tumors,and compare the efficacy of the two scoring methods in the differential diagnosis of IDP and breast cancer.Methods: Retrospective analysis was made on 104 cases of breast masses treated in our hospital and confirmed by pathology from June 2018 to September 2022,including 44 cases of intraductal papilloma and 60 cases of breast cancer.Both conventional ultrasound and contrast-enhanced ultrasound were performed in our hospital.The characteristic images observed by conventional ultrasound included the size,shape,edge,echo pattern,internal uniformity,calcification,and vascular condition of the lesion.According to the image characteristics,IDP was divided into three types: intraductal type,intracapsular type,and solid type.According to BI-RADS(Version 5),the BI-RADS classification of IDP group and breast cancer group was compared.The characteristics observed by contrast-enhanced ultrasound include enhancement intensity,enhancement sequence,enhancement uniformity,morphology after enhancement,boundary after enhancement,crab foot sign around the tumor,enhancement phase and whether the enhancement scope is expanded or not,and were compared with the contrast-enhanced characteristics of breast cancer masses.To evaluate the efficacy of two diagnostic management strategies,namely,combination method I(5 points)and combination method II(10 points),in the differential diagnosis of IDP and breast cancer.Results: In the features of contrast-enhanced ultrasound(CEUS)of IDP and breast cancer,there were statistically significant differences(P<0.05)in enhancement sequence(p=0.000),enhancement phase(p=0.000),range after enhancement(p=0.000),crab foot sign after enhancement(p=0.000),and boundary after enhancement(p=0.010),while there were no statistically significant differences(P>0.05)in enhancement intensity,uniformity,and morphology after enhancement(P>0.05).In the contrast-enhanced ultrasound features of solid block type IDP and breast cancer,there were statistically significant differences(P<0.05)in enhancement phase(p=0.000),post enhancement range(p=0.001),post enhancement boundary(p=0.002),and post enhancement crab foot sign(p=0.000),but there were no statistically significant differences(P>0.05)in enhancement intensity,enhancement uniformity,enhancement order and post enhancement morphology.The area under the ROC curve(AUC)of routine ultrasound diagnosis of IDP and breast cancer is 0.670(95% CI: 0.558~0.770),the sensitivity is 1.000,the specificity is 0.318,the positive predictive value(PPV)is 0.800,and the negative predictive value(NPV)is 1.000.The area under the ROC curve for the combined method one diagnosis of IDP and breast cancer was 0.849(95% CI: 0.407~0.828),the sensitivity was 0.883,the specificity was 0.636,the positive predictive value(PPV)was 0.869,and the negative predictive value(NPV)was 0.667.The area under the ROC curve for the combined method two diagnosis of IDP and breast cancer was 0.912(95% CI: 0.828~0.963),the sensitivity was 0.883,the specificity was 0.818,the positive predictive value(PPV)was 0.930,and the negative predictive value(NPV)was 0.720.Conclusion: Conventional ultrasound combined with contrast-enhanced ultrasound(CEUS)has a good ability to differentiate IDP from breast cancer,especially for ductal dilatation type and intracapsular type IDPs.Combined method 1 and combined method 2 can be used as ultrasound diagnosis management strategy for differential diagnosis of IDP and breast cancer,and combined method two which is more worthy of clinical promotion and application has better diagnostic efficiency than combined method one.