The Value Of Quantitative Parameters Of Contrast-enhanced Ultrasound In The Management Of BI-RADS 4a Breast Lesions

Objective:To investigate the application value of quantitative parameters of contrast-enhanced ultrasound in the management of BI-RADS 4a breast lesions.Methods:Retrospective analysis was performed on 373 pathologically confirmed breast lesions in June 2017 to December 2019 in guangxi medical university affiliated tumor hospital.On the basis of conventional ultrasound BIRADS classification,BI-RADS classification was adjusted according to the qualitative characteristics of contrast-enhanced ultrasound.The region of interest was determined by dynamic contrast using the software of ultrasound diagnostic instrument,and time-intensity curves were drawn and quantitative parameters were recorded.With pathological diagnosis as the gold standard,the differences of quantitative parameters of CEUS in breast benign and malignant lesions were compared,and the quantitative parameters with statistical significance were selected to construct ROC curves to obtain the optimal cut-off values.BI-RADS were separately divided according to the optimal cut-off values of quantitative parameters.According to the optimal cutoff value of quantitative parameters,biRADS 4a lesions were stratified into low-risk and high-risk lesions.Different Suggestions were put forward for the management of high and low risk lesions,short-term follow-up was adopted for low risk lesions,and biopsy was required for high risk lesions.To compare the difference of biopsy requirement rate and malignant detection rate of BI-RADS 4A lesions before and after risk stratification assessment,and the difference of biopsy requirement rate and malignant detection rate between each group after risk stratification assessment.Results:Among 373 breast lesions,83(22.25%)were benign,290(77.75%)were malignant,and there were 59 lesions in the BI-RADS 4a category,which includes 57 benign lesions(96.61%)and 2 malignant lesions(3.39%).The peak intensity,area under the TIC curve and wishin area of CEUS quantitative parameters were different between benign and malignant breast lesions(P<0.05).The area under the ROC curve of the peak intensity,area under the TIC curve and wish in area was 0.736,0.740 and 0.721,and the Youden index was 0.354,0.346 and 0.356,respectively.The optimal cut-off value score was 0.1.55,110.5 and 5.65,respectively.The best cut-off values of peak intensity(group A),area under the TIC curve(group B),wish in area(group C)and combination of the three(group D)were used to assess the risk of all BI-RADS 4a lesions:35(59.32%)in low-risk group A,24(40.68%)in high-risk group A,35(100%)in benign and 0(0%)in low-risk group A,22(91.67%)in benign and 2(8.33%)in high-risk group A;40(67.80%)in low-risk group B,19(32.20%)in high-risk group B,40(100%)in benign and 0(8.33%)in low-risk group B(0%),17(89.47%)were benign and 2(10.53%)were malignant in high-risk group B;33(55.93%)were low-risk group C,26(44.07%)were high-risk group C,33(100%)were benign,0(0%)were malignant,24(92.30%)were benign and 2(7.70%)were malignant in highrisk group C;40(67.80%)in low-risk group D,19(32.20%)in high-risk group D,40(100%)in benign and 0(8.33%)in low-risk group D(0%),17(89.47%)were benign and 2(10.53%)were malignant in high-risk group D.Before grouping,the biopsy rate of BI-RADS 4a lesions was 100%,and the detection rate of malignancy was 3.38%.After risk stratified assessment of group A,group B,group C and group D,the biopsy rate of each group decreased,which were 40.68%,32.20%,44.07%and 32.20%.The difference was statistically significant(χ2A=49.759,χ2B=60.513,χ2c=45.812,χ2D=60.513,P<0.05),and the detection rate of malignancy increased in group A,group B,group C and group D,which were 8.33%,10.52%7.69%and 10.52%.The difference was not statistically significant(Fisher test,P>0.05);there was no significant difference in the biopsy rate between the groups after risk stratification assessment(χ2=1.853,P>0.05),and there was no significant difference in the detection rate of malignancy(Fisher test,P>0.05).Conclusion:1.The time-intensity curve of contrast-enhanced ultrasound drawn by dynamic comparison showed the peak intensity,the area under the TIC curve and the wishin area were different among benign and malignant breast lesions.The peak intensity,the area under the TIC curve and the wishin area of malignant lesions were higher than benign lesions,The optimal cutoff values of the them were 1.55,110.5 and 5.65,respectively.2.Using CEUS quantitative parameter peak intensity,area under the TIC curve and wish in area to carry out risk stratification management of BI-RADS 4a lesions,perform biopsy of high-risk lesions,and short-term follow-up of lowrisk lesions,which can avoid missed diagnosis of malignant lesions and the reducing biopsy of benign lesions.