The diagnostic value of contrast-enhanced ultrasonography in breast ductal abnormalities

Abstract

Background Ductal lesions are an important, often overlooked, and poorly understood issue in breast imaging, which have a risk of underlying malignancy ranging from 5 to 23%. Ultrasonography (US), which has largely replaced galactography or ductography, has become an important imaging method to assess patients with ductal lesions. However, it is difficult to distinguish benign from malignant ductal abnormalities only by ultrasonography, most of which are recommended to be at least in subcategory 4A; these require biopsy according to the ACR BI-RADS®atlas 5th Edition-breast ultrasound. Contrast-enhanced ultrasound (CEUS) has been shown to be valuable for differentiating benign from malignant tumors, but its value is unclear in breast ductal lesions. Therefore, the purposes of this study were to explore the characteristics of malignant ductal abnormalities on US and CEUS imaging and the diagnostic value of CEUS in breast ductal abnormalities. Methods Overall, 82 patients with 82 suspicious ductal lesions were recruited for this prospective study. They were divided into benign and malignant groups according to the pathological results. Morphologic features and quantitative parameters of US and CEUS were analyzed by comparison and multivariate logistic regression to determine the independent risk factors. The diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis. Results Shape, margin, inner echo, size, microcalcification and blood flow classification on US, wash-in time, enhancement intensity, enhancement mode, enhancement scope, blood perfusion defects, peripheral high enhancement and boundary on CEUS were identified as features correlated with malignant ductal lesions. However, multivariate logistic regression showed that only microcalcification (OR = 8.96, P = 0.047) and enhancement scope (enlarged, OR = 27.42, P = 0.018) were independent risk factors for predicting malignant ductal lesions. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the ROC curve of microcalcifications combined with an enlarged enhancement scope were 0.895, 0.886, 0.872, 0.907, 0.890, and 0.92, respectively. Conclusions Microcalcification and enlarged enhancement scope are independent factors for predicting malignant ductal lesions. The combined diagnosis can greatly improve the diagnostic performance, indicating that CEUS can be useful in the differentiation of benign and malignant lesions to formulate more appropriate management for ductal lesions.

Clinical characteristics and prognosis of 69 cases of neonatal appendicitis

“…When typical direct signs of the appendix are lacking in neonates owing to its anatomical features, attention should be paid to the indirect signs, 25 including fluid accumulation in the right lower abdomen, thickened echogenic enhancement of the greater omentum in the right lower abdomen, and enlarged mesenteric lymph nodes in the right lower abdomen. 26 Most scholars recommend immediate appendectomy for NA and that dissection or laparoscopic exploration is feasible when appendicitis is suspected early. 13,21,27 Owing to the complexity of early diagnosis and rapid NA progression, most cases involve perforation at diagnosis, with heavy peri-appendiceal adhesions and appendiceal abscesses, making surgical resection challenging.…”

Mammographically detected breast clustered microcalcifications localized by chest thin-section computed tomography

“…Ductal carcinoma in situ (DCIS), which is typically detected based on the presence of clustered microcalcifications in mammography, is an early stage of breast cancer with an excellent prognosis. Although ultrasound has the capability to visualize large clusters of microcalcifications [ 2 ], mammography remains the most important approach for detecting and depicting microcalcifications in the breast, an additionally performed breast MRI could have increased the diagnostic reliability in the assessment of microcalcifications [ 3 ].…”