Characteristics Of Breast Neoplasms On Contrast-enhanced Ultrasonography And Its Clinical Value

Objective To investigate the characteristics of breast neoplasms on contrast-enhancedultrasonography and its clinical value.Materials and methods225female patients with breast masses unable to be diagnosedby conventional ultrasonography were examined with contrast-enhancedultrasonography (CEUS). Their ages range were12to85years, the mean age was(45.8±17.6) years.225cases were investigated. For cases of multiple lesions, performedwhich was the highest classification level of BI-RADS; for the lesions of the same level,performed the largest lesion. The characteristics of these masses on CEUS wereanalyzed and compared with the results of pathology examination. All the fundamentalultrasound examinations were performed by the Siemens Sequoia Acuson512or PhilipsiU22, which were matched with contrast pulse sequence (CPS）imaging technique. Thefrequency used in the mode of gray-scale US was7to12MHz, with4to8MHz in themodes of CEUS, respectively. Mechanical index(MI) was less than1.5. The contrastagent(UCA) was SonoVue (Bracco，Italy). Dissolve the SonoVue power with5ml saline,then dump the solution and inject it to patient’s body quickly(within3seconds) by theneedle which was set in cubital vein, and inject5ml saline to body. The process ofCEUS was divided into three phases, early (after injection to1min), medium-term (1to4min), late (4to6min). The characteristics of breast neoplasms on CEUS imaging wereinvestigated from6aspects: lesions shapes, boundary of the enhanced lesions, featuresof the vessels, distribution of contrast enhancement/perfusion defect of contrast signals,local retention of contrast signals/the exporting of contrast signals from the lesions, maximum diameters of the lesions after injection of the contrast media. Twoinvestigators blinded to sonographic findings made the assessment on the CEUSimaging data.Results91cases were malignant and134cases were benign. The91malignaciesdisplayed: irregular shapes were80.2%(73/91), tortuous, massive or penetrating vesselswere86.8%(79/91), heterogeneous distribution of contrast enhancement were83.5%(76/91),perfusion defect of contrast signals were89.0%(81/91), local retention ofcontrast signals were93.4%(85/91), rapidly exporting from the lesions were65.9%(60/91). Significant differences of above CEUS characteristics were found between thebenign and malignant breast lesions (P<0.05), The two most important features wereperfusion defects and local retention of the contrast signals, with the sensitivity andspecificity attained to89.0%and91.8%, and93.4%and92.5%, respectively. Poorlydefined boundaries of the91malignacies were64.8%(59/91), and the specificity was47.8%。The malignant cases had enlarged maximum diameter on CEUS compared topre-contrast (P<0.05).Conclusion The typical features of breast cancers on CEUS were irregular shapes,tortuous, massive or penetrating vessels, heterogeneous distribution of contrastenhancement, with perfusion defect or local retention of contrast signals, rapidlyexporting from the lesions, enlarged maximum diameter of the lesions on CEUScompared to pre-contrast. It is valuable for CEUS in the diagnosis and differentialdiagnosis of breast neoplasms clinically.