Evaluation Of Contrast-Enhanced Ultrasonography Breast Predictive Model In Optimizing Breast Lesions BI-RADS Classification

Objective To explore the value of contrast-enhanced ultrasonography(CEUS)breast predictive model in the optimization of BI-RADS category of breast lesions.Methods The BI-RADS 4 and 5 breast lesions were included in the group,Physicians who performed CEUS at each center have more than 2 years of experience or have examined more than 1000 cases.All breast lesions were reclassified according to the CEUS prediction model and category 3,4A,4B and 4C were set separately.The diagnostic sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Jordanianindex were calculated for the biopsy threshold.Comparison of biopsy rate to breast lesions before and after angiography,cancer detection rate follow-up cases of malignant risk.Results From November 2015 to April 2017,a total of 1049 breast lesions(1039patients from 8 study centers in China)in BI-RADS category 4 and 5 were included.There were 586 benign lesions(55.9%)and 463 malignant lesions(44.1%).All the patients were female,age 18-84 years old,with an average age of(44.9 ± 10.9)years.The maximum diameter of the lesion was 5.0 ~ 40 mm,with the mean maximum diameter(17.1 + 8.6)mm.After CEUS,244(23.3%)of the breast lesions were classified into BI-RADS 3,BI-RADS 4A were reduced from 431(41.1%)to 22(21.2%),BI-RADS 4B were reduced from 302(28.8%)to 129(12.3%),BI-RADS 4C increased from 138(13.2%)to 153(14.6%),BI-RADS 5 increased from 178(16.9%)to 301(28.6%).The diagnostic sensitivity,specificity,accuracy,positive predictive value and negative predictive value of being reclassified 4A as the threshold for biopsy after CEUS were 93.32%,75.65%,82.75%,75.57% and 93.35%respectively,and the Jordanianindex index was 0.690.The biopsy rate was reduced from 100% to 76.74% and the cancer detection rate increased from 44.23% to 56.77%when lesions were reclassified 3 as the threshold for biopsy after CEUS,however,the risk of malignancyin the follow-up cases was 0.67%.The biopsy rate was reduced from 100% to 55.58% and the cancer detection rate increased from 44.23% to74.44%,when lesions were reclassified 4A as the threshold for biopsy after CEUS,however,the risk of malignancyin the follow-up cases was 2.96%.when lesions were reclassified 4B as the threshold for biopsy after CEUS,cancer detection rate,biopsy rate and malignant risk were 83.70%,43.28% and 8.1% respectively.when lesions were reclassified 4C as the threshold for biopsy after CEUS,cancer detection rate,biopsy rate and malignant risk were 88.70%,28.69%and 18.88%.If the malignant tumor is the main lesion of interest,then the malignant risk of BI-RADS 3,4 A,4B and 4C is 0.67%,2.96%,8.10 and 18.88% respectively after CEUS.Conclusion This study shows that the biopsy rate of breast lesions in category 4 and5 would be reduced and cancer detection rate of them would be increased after CEUS,however,the risk of malignancyin the follow-up cases would be controlled as low as category 3 and 4A in previous BI-RADS.Thus,CEUS has a good prospect of in optimizing BI-RADS and reducing biopsy rate in unnecessary lesions.