Comparison Of Diagnostic Efficacy Of Contrast-enhanced Ultrasound And Dynamic Enhanced MRI In Breast Lesions

PurposeThis study aims to evaluate the application value of conventional ultrasound（US）combined with contrast-enhanced ultrasound（CEUS）and dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI）in the diagnosis of breast diseases compare.Materials and MethodsA retrospective study of 252 patients with breast lesions who underwent routine US combined with CEUS and DCE-MRI before surgery from January 2016 to February2020.Take the surgical pathology result as the gold standard.All patients were divided into tumor-like and non-tumor-like lesion groups.The mass-like lesion group was divided into three groups according to different sizes（group 1:<10mm,group 2:10-20 mm,group 3:>20 mm）.The ROC（receiver operating characteristic curve）curve was used to evaluate the diagnostic performance of these two inspection methods and to analyze the sensitivity,specificity,positive predictive value and negative predictive value of the two inspection methods among different groups.ResultA total of 252 cases of breast lesions were included in this study,of which 200 cases were mass lesions,52 cases were non-mass lesions,148 cases were benign lesions in general,and 104 cases were malignant lesions.1.For mass-like lesions,there are statistically significant differences in the shape,edge,orientation,and rear echo of the lesion（all P values are less than 0.05）.The enhancement mode（uniform enhancement and enhancement）and enhancement degree（high enhancement,equal enhancement,low enhancement）of the lesions in CEUS and DCE-MRI are statistically significant between benign and malignant lesions（all P values<0.05）,Malignant lesions are mostly uneven and high enhancement.The average ADC value（Apparent Diffusion Coefficient）of the malignant group is（0.93±0.24）*10^-3mm²/s,and the benign group is（1.46±0.16）*10^-3mm²/s.The difference in ADC value between benign and malignant lesions was statistically significant（P=0.002）.The TIC curves of malignant lesions are mainly plateau type（or type 2 kinetics）and elution type（or type 3 kinetics）（39.3%and 29.7%respectively）,and the TIC curves of benign lesions are mainly increasing type and plateau type（53.6%and 25.0%,respectively）,the difference in TIC curve is also statistically significant（P<0.001）.2.A total of 52 cases of non-mass breast lesions were included in this study,of which 2 cases had no positive manifestations on CEUS.The image characteristics of50 lesions with positive manifestations in US combined with CEUS were statistically analyzed,and the results showed that there were 37 cases.It was a mass with a certain sense of space,and 13 cases showed irregular flaky hypoechoic.The differences in the image features of non-mass lesions under ultrasound,including shape,edge,direction,and rear echo were statistically significant（all P values<0.05）.The enhancement mode（uniform enhancement and uneven enhancement）and enhancement degree（high enhancement,equal enhancement,low enhancement）of CEUS and DCE-MRI have statistically significant differences（P<0.05）.The ADC value of malignant lesions is（1.3±0.24）*10^-3mm²/s,the average ADC value of benign lesions is（0.90±0.17）*10^-3mm²/s,which is between the ADC values of DCE-MRI in benign and malignant lesions The difference was statistically significant（P<0.001）.3.The diagnostic efficacy of the two imaging methods in mass-like breast lesions is basically the same in different size groups.Only in the 10-20 mm group,DCE-MRI（Az=0.981）is better than conventional US combined with CEUS（Az=0.940）had better diagnostic power and the difference was statistically significant（Z=2.018,P=0.043）.In the<10 mm group and>20 mm group,both have high diagnostic efficiency.The diagnostic efficiency of conventional US combined with CEUS in the<10mm group is 0.952,the diagnostic efficiency of DCE-MRI is 0.968,and the diagnostic efficiency of conventional US combined with CEUS in the>20mm group The diagnostic power of DCE-MRI was 0.951,and the diagnostic power of DCE-MRI was 0.926,but there was no statistically significant difference in diagnostic power between the two（P=0.717,P=0.394,respectively）.For non-mass breast lesions,both showed good diagnostic power（Az=0.859,Az=0.947,respectively）,and the difference in diagnostic power was not statistically significant（Z=1.590,P=0.119）.4.The sensitivity,specificity,positive predictive value（PPV）and negative predictive value（NPV）of CEUS and DCE-MRI in distinguishing benign and malignant breast lesions were compared for all cases,mass groups,and non-mass groups included in the study.For all breast lesions,the specificity and PPV of DCE-MRI are higher than CEUS（89.2%vs 81.8%,85.7%vs 78.4%,respectively）,but the sensitivity and NPV are lower（92.3%vs 94.2%,94.3,respectively）%vs95.3%).For mass-like lesions,the sensitivity and NPV of CEUS were 92.7%and95.1%,respectively,which were higher than the sensitivity and NPV of DCE-MRI（82.9%and 94.1%,respectively）.For non-mass breast lesions,the sensitivity,specificity,and PPV of DCE-MRI were 91.7%,89.7%,and 73.3%,respectively,which were slightly higher than the sensitivity,specificity,and PPV of CEUS（75.0%,76.9%,41.4%,respectively）.Conclusion1.Both conventional US and CEUS can effectively display the relevant characteristics of various types of breast lesions and provide corresponding diagnostic information.2.For mass breast lesions,DCE-MRI shows better diagnostic performance than CEUS in distinguishing medium-sized（10-20 mm）benign and malignant breast tumors;for breast tumors<10mm and>20mm,CEUS shows The diagnostic performance is consistent with DCE-MRI.The overall breast lesion group and the non-mass breast lesion group,both methods show similar diagnostic performance.3.For all breast lesions,the specificity and PPV of DCE-MRI are higher than CEUS,but the sensitivity and NPV are lower.For mass-like lesions,the sensitivity and NPV of CEUS are higher than those of DCE-MRI.For non-mass breast lesions,DCE-MRI has higher sensitivity,specificity and PPV than CEUS.4.For those patients who cannot undergo DCE-MRI due to various active or passive reasons,CEUS is a reliable alternative and provides effective auxiliary information for patients with breast diseases to develop personalized diagnosis and treatment plans.