Research Of Contrast-enhanced Ultrasound Combined With Multiparameter For Distinguishing Benign And Malignant Breast Masses

Objective The aim of this study was to evaluate the value of Contrast-enhanced Ultrasound(CEUS)techniques independently and in combination in the differential diagnosis of benign and malignant breast masses,in order to improve the diagnosis rate of breast masses,improve the diagnostic accuracy.The application value of Arrival-time Parametric Imaging(ATPI)as a new ultrasound technique was evaluated.Methods A total of 104 female patients(107 nodules)who did ultrasound and CEUS exams,and obtained definite pathological results by coarse needle biopsy or surgical excision from September 2021 to December 2022 at the General Hospital of Northern Theater Command were selected.The pathological results were the gold standard.The CEUS characteristics,time-intensity curve(TIC)parameters,perfusion time(△T)under ATPI of benign and malignant groups were analyzed by statistical approach.Four diagnostic prediction models were established for the results which had statistical significance by binary logistic regression analysis.The models were CEUS characteristics,TIC parameters,CEUS characteristics + TIC parameters and CEUS characteristics+TIC parameters+△T.The area under the curve(AUC)was calculated by plotting the receiver operating characteristics curves(ROC)for each prediction model to evaluate the diagnostic performance.The statistical significance of difference between diagnostic performance were analyzed.The causes of misdiagnosed by the prediction model of CEUS characteristics were analyzed.The diagnostic efficaciency of each independent parameter was assessed and Youden index was calculated to obtain the cut-off value.The consistency of perfusion characteristics observed by ATPI and the CEUS was analyzed.Results 1.53 benign and 54 malignant lesions were found in 107 cases.There were significant differences between the two groups in the CEUS imaging characteristics(P<0.05).The characteristics of benign lesions were diffuse,simultaneous or slow perfusion and hypoenhancement or isoenhancement,otherwise,malignant lesions mostly were fast inhomogeneous perfusion and hyperenhancement.The malignant lesions mostly were seen increased area,with or without defects,nourish blood vessels and the ‘crab foot sign’ enhanced.The order of enhancement is mostly centripetal.2.In TIC parameters,malignant lesions was earlier benign lesions in the aspects of time to peak(Tto PK-I)and arrive time(ATm-I),and higher in the aspects of the area under the curve(Area-I)and gradient(Grad-I).The values of area under the curve of single parameter Tto PK-I,Area-I,Grad-I(d B/s)and ATm-I(s)were 0.728,0.682,0.724 and 0.654 respectively.The value of the area under the curve of the △T in ATPI was0.746,which was higher than the the four above,however,the difference did not have statistical significance(P>0.05).The cut-off value of △T was 8.47.3.The evaluation of lesion characteristics by ATPI was in high consistency with CEUS’s.The Kappa values for the five characteristics including enhancement time,enhancement sequence,area of the enhanced lesion,presence or absence of enhancement defects and nourish blood vessels were 0.924,0.923,0.903,0.878 and0.938 respectively.It’s advantage of visualization can be used as complement and validation of CEUS.4.The value of area under the ROC of prediction model of CEUS characteristics+TIC parameter+△T(0.947)was higher than prediction models of CEUS characteristics and CEUS characteristics+TIC parameter(0.903,0.946).The diagnostic accuracy,sensitivity,and specificity of the prediction model of CEUS characteristics+TIC parameter+△T was better than CEUS characteristics.(86.92%,88.89%,and 84.91% vs85.98%,87.04%,and 84.91%).Those difference had statistical significance(P<0.05).This prediction model of CEUS characteristics+TIC parameter+△T avoided the occurrence of one case misdiagnosis effectively.Conclusion CEUS can help us to identify malignant and benefit lesions and have good diagnostic efficaciency in predicting the benignity and malignancy of BI-RADS 4lesions.The diagnostic efficaciency of the prediction model of CEUS characteristics+TIC parameters+△T established in this study was higher than that of CEUS characteristics and CEUS characteristics+TIC parameters.Furthermore,it’s sensitivity,diagnostic accuracy,positive predictive value and negative predictive value were improved.The prediction model of CEUS characteristics+TIC parameters+△T reduced unnecessary punctures,provided more accurate and objective basis for clinical diagnostic work,and enhanced the diagnostic confidence of ultrasonographers.As a new technology,ATPI enables visualization of perfusion characteristics and has a higher consistency with the gray-scale CEUS characteristics.Its quantitative parameters improve objectivity and have great importance to differential diagnosis of benign and malignant lesions.