Determining whether the diagnostic value of B-ultrasound combined with contrast-enhanced ultrasound and shear wave elastography in breast mass-like and non-mass-like lesions differs: a diagnostic test

Abstract

Background: Mass-like (ML) and non-mass-like (NML) are two manifestations of breast lesions on ultrasound. Contrast-enhanced ultrasound (CEUS) can make up for the limitation of B-ultrasound (US) in the observation of focal blood flow, and shear wave elastography (SWE) can supplement the hardness information of the lesion. The present study aimed to analyze the characteristic manifestations of US, CEUS, and SWE in NML and ML breast and evaluate whether the diagnostic performance of these three ultrasound techniques differs in terms of differentiating between benign and malignant breast lesions.Methods: From January to August 2021, 382 patients (417 breast lesions) underwent US, CEUS, and SWE examinations. Of these, 204 women (218 breast lesions) were included in our study due to subsequent biopsy or surgery with pathological findings. The patients were divided into ML and NML groups according to the ultrasound characteristics, and the differences in multimodal ultrasound performance between benign and malignant NML and benign and malignant ML breast lesions were compared. The diagnostic performance of US, US + CEUS, US + SWE, US + CEUS + SWE for ML, NML and all breast lesions was evaluated by analyzing sensitivity, specificity and area under receiver operating characteristic (ROC) curve (AUC).Results: Pathologically, the 218 lesions included 96 malignant and 122 benign breast lesions. The sensitivity and specificity of US + CEUS + SWE in all lesion groups, ML group and NML group were 92.7% and 90.2%, 95.9% and 90.3%, 91.3% and 79.3%, respectively. In all breast group, AUCs of US + CEUS, US + SWE, US + CEUS + SWE were statistically different from AUC of US (P=0.0010, 0.0001, 0.0001). In the ML group, the AUC of US + CEUS, US + SWE, US + CEUS + SWE were statistically different from that of US (P=0.0120, 0.0008, 0.0002). In the NML group, there was a statistical difference between US + SWE and US AUC (P=0.0149).Conclusions: US, CEUS, and SWE have an important diagnostic value for benign and malignant ML and NML breast lesions. Multimodal ultrasound combined with US, CEUS, and SWE can improve the diagnostic efficacy in distinguishing between benign and malignant ML and NML lesions.

Value of sonoelastography for diagnosis of breast non-mass lesions and comparison with BI-RADS: A systematic review and meta-analysis

“…[ 26 ] Li S-Y et al analyzed the features of breast non-mass lesions on B-mode US, CEUS, and shear-wave elastography (SWE) and discovered that the combination of conventional US and SWE had the highest AUC of 0.935. [ 14 ] Wang F et al explored the combined application of SWE and a novel blood flow imaging technique called Angio PLUS microvascular US imaging for diagnosing breast non-mass lesions and found an accuracy of 78.3% to 88.3%. [ 27 ] These studies indicated that sonoelastography played a good complementary role on conventional US.…”

“…Some studies have shown that sonoelastography has important value in the diagnosis of breast diseases, especially for non-mass lesions. [ 13 , 14 ] The aim of our study was to summarize the diagnostic performance of sonoelastography for breast non-mass lesions and determine the application value of this technology.…”

A comparative study on the features of breast sclerosing adenosis and invasive ductal carcinoma via ultrasound and establishment of a predictive nomogram

“…According to previous studies, clinical nomograms have been applied to breast diseases in numerous aspects, such as predicting breast cancer, assessing the diagnostic performance of imaging methods in breast diseases ( 18 – 21 ), predicting axillary lymph node metastasis of breast cancer ( 22 ), and predicting the recurrence rate and risk of breast cancer ( 23 ), etc. In the ultrasonic differentiation between SA and malignant tumors, the findings of Liang’s study were consistent with ours ( 17 ).…”

“…Compared with IDC, the size of SA nodules is smaller, and SA does not clinically manifest symptoms, thereby complicating palpation and preoperative ultrasonic diagnosis. Therefore, this ultrasound-based comparative study between SA and IDC enabled the construction of a nomogram to assist ultrasound physicians in not only further analyzing the value of various ultrasonic features in SA diagnosis but also calculating the total score on the nomogram to predict the risk of SA (17)(18)(19). Our research indicated that age, nodule size, menopausal status, presence of clinical symptoms, palpability of lesions, margins, internal echo, CDFI grading, and RI could be used as predictive factors for distinguishing between SA and IDC.…”

Status and Progress of Multimodal Ultrasound Diagnosis of Triple-negative Breast Cancer

“…Ultrasound is frequently used in detecting and screening breast cancer since it is a secure, non-invasive, and affordable imaging technique. Breast lesions, both benign and malignant breast lesions, can be more accurately diagnosed using multimodal ultrasonography [12][13][14][15][16] . TNBC frequently exhibits the characteristics of benign tumors on conventional ultrasound imaging, even though various molecular subtypes of breast cancer might exhibit diverse appearances on sonogram s [17] .…”