| Objective To explore the application value of multimodal ultrasound images based on conventional ultrasound(CUS),ultrasound elastography(UE)and contrast-enhanced ultrasound(CEUS)in the differential diagnosis of benign and malignant breast masses ≤20mm in maximum diameter.Method We retrospectively analyzed 195 cases of breast masses ≤20 mm in maximum diameter that were seen in our hospital and underwent surgery between January 2021 and October 2022,analyzed their CUS,UE,and CEUS findings,compared the CUS,UE,and CEUS ultrasound imaging characteristics of benign and malignant breast masses ≤20 mm in maximum diameter,and used logistic regression to analyze the malignant maximum diameter≤20 mm.We also used logistic regression to analyze the risk factors of multimodality ultrasound imaging for malignant breast masses ≤20 mm in maximum diameter,and further compared the diagnostic efficacy of single US,UE,CEUS and multimodality ultrasonography for breast masses ≤20 mm in maximum diameter.Results 1.Among 195 breast masses ≤20 mm in maximum diameter,142 were benign,with a 72.82%incidence of benign lesions,and 53 were malignant,with a 27.18%incidence of malignant lesions.2.In terms of CUS,compared to the benign group,the malignant group had a higher incidence of irregular morphology(64.79%vs 92.45%),poorly defined borders(7.04%vs 64.15%),posterior echogenic attenuation(33.10%vs 58.49%),microcalcifications(16.20%vs 50.94%),and aspect ratio>1(14.79%vs 52.83%),blood flow grading Ⅰ～Ⅲ[27.46%vs 47.17%,6.34%vs 28.30%,0.00%vs 1.89%]were significantly higher in proportion,with statistically significant differences(P<0.001).3.For UE,the elasticity score was significantly higher in the malignant group than in the benign group[(3.58±0.78)points vs.(2.28±0.74)],and the difference was statistically significant(t=10.754,P<0.001);the optimal threshold for benign and malignant was≥4 points,and the difference was statistically significant(P<0.05).4.For CEUS,the malignant group had earlier onset of enhancement than the surrounding tissue(69.81%vs.16.20%),hyperenhancement(71.70%vs.21.13%),centripetal enhancement(77.36%vs.21.83%),contrast inhomogeneity(83.02%vs.60.56%),poorly defined borders(86.79%vs.40.14%),perfusion defects(58.49%vs.23.24%),increased extent of enhancement(58.49%vs.5.63%),and peripheral penetrating vessels(28.30%vs.2.11%)were significantly higher than those in the benign group,and all differences were statistically significant(P<0.05).5.The results of multifactorial logistic regression analysis suggested that independent risk factors for malignant breast masses ≤20 mm in maximum diameter included high enhancement[OR:8.523,95%CI:3.644 to 13.989],contrast inhomogeneity[OR:9.242.95%CI:4.313 to 16.555],and unclear borders[OR:4.641.95%CI:1.455～7.899],perfusion defects[OR:7.898,95%CI:2.255～1.921],and increased extent of enhancement[OR:1.783,95%CI:1.401～5.744],all with statistically significant differences(P<0.05).6.In the differential diagnosis of benign and malignant breast masses ≤20 mm in maximum diameter,the sensitivity,specificity,and accuracy of US were 71.70%,71.13%,and 71.28%,respectively;the sensitivity,specificity,and accuracy of UE were 69.81%,97.18%,and 89.74%,respectively;the sensitivity,specificity,and accuracy of CEUS were 84.91%,83.80%,84.10%,and the sensitivity,specificity,and accuracy of multimodal ultrasound were 94.34%,98.59%,and 97.44%,respectively,which were significantly higher than those of single CUS,UE,and CEUS(P<0.05).Conclusions CUS,UE and CEUS have certain application value in the differential diagnosis of benign and malignant breast micro-masses,but there are cases of misdiagnosis and missed diagnosis.Multimodal ultrasound can further improve the differential diagnosis ability of benign and malignant breast micro-masses,which is worthy of further clinical application and promotion. |
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