| Objectives To investigate the diagnostic efficacy of contrast-enhanced ultrasound(CEUS)in diagnosis of benign and malignant breast lesions by summarizing the imaging characteristics of breast lesions, the quantitative parameters of CEUS.Methods A total of 80 lesions from 76 female patients who were diagnosed as breast solid neoplasm were examined by CEUS before surgery.Their ages range were 19 to 79 years. The focal diameter range were 6.00~57.00 mm. All the cases were acquired the surgical and pathological confirmation.All the contrast enhanced ultrasound examinations were performed by the TOSHIBA Aplio 500 color Doppler ultrasonoscope. The contrast agent was media(Sono Vue).Injection dose was 2.4ml. Observe and reserve the dynamic contrast-enhanced ultrasound progress. Downloaded and analyzed all the data.The morphology of breast lesions on CEUS imaging were investigated from 6 aspects:1)enhancement intensity, 2)enhancement pattern, 3)boundary of the enhanced lesions,4)distribution of contrast enhancement, 5)penetrating artery, 6) perfusion defect.The quantitative parameter included: 1) the lesions’ area before and after CEUS. 2)The time-intensity curves: arrive time(AT)、time to peak(TTP)、peak intensity(PI).All the parameters were used to score the enhanced performance of the lesions.The statistical analysis was performed using the chisquared test or the t-test. In addition to these test, receiver operating characteristic(ROC) curves were developed.Results1. The pathological result: a total of 80 lesions included 34 malignant lesions and 46 benign lesions.2. The qualitative result:1) Most malignant lesions displayed high(70.59%) and heterogeneous enhancement(73.53%) with indistinct boarder(76.47%), penetrating artery(58.82%) and perfusion defect(52.94%).2) In benign lesions 29 displayed moderate or low enhancement, 34 showed homogeneous enhancement, 33 with distinct boarder.3) Significant differences of above CEUS morphology characteristics were found between the benign and malignant breast lesions(P<0.05).4) The sensitivity of boarder, distribution and contrast degree was 76.47%, 73.53%,70.59%, respectively. The specificity of penetrating artery and perfusion defect was86.96%, 82.61%,respectively.3. The quantitative result:1) The area post-contrast examination of malignant lesions was significantly larger than pre-contrast(t=3.54, P<0.05). The area ratio between benign and malignant lesions were significantly different(t=4.18, P<0.05).2) There was significant difference in peak intensity(PI) between benign and malignant lesions(t=3.91, P<0.05).3) The areas under ROC curves of AR and PI were 0.81、0.78. The cut off point of AR and PI value were determined as 1.24 、 4.55×10-5AU, and the sensitivity and specificity were 81.80%、70.40%; 54.50%, 88.90%, respectively. If the cut off point were determined as 1.69 and 6.25×10-5AU, the specificity were 100%4. The general result:The sensitivity, specificity and accuracy of CEUS overall scoring system in the diagnosis of breast lesions were:91.18%、84.78%、87.50%.Conclusions1. The characteristics of benign lesions were moderate or low enhancement,homogeneous enhancement, with indistinct boarder.2.The characteristics of malignant lesions were high and heterogeneous enhancement with indistinct boarder, penetrating artery and perfusion defect.3.The cut off point of AR and PI were determined as 1.24、4.55×10-5AU.4. The sensitivity, specificity and accuracy of CEUS overall scoring system in the diagnosis of breast lesions were: 91.18%、84.78%、87.50%.5.It is valuable for CEUS in the diagnosis and differential diagnosis of breast neoplasms. |
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