The Clinical Application Of Contrast Enhanced Ultrasound In The BI-RADS 4 Types Breast Lesions

Objective : To explore the clinical application value of conventional ultrasound(US)combined with contrast enhanced ultrasound(CEUS)in the differentiation of BI-RADS4 breast lesions from benign to malign ant,to find a new method to improve BI-RADS4 breast lesions,to optimize BI-RADS classification and to provide effective help for clinical diagnosis and treatment.Methods: From June 2019 to January 2020,59 cases(60 breast lesions)of BI-RADS4 were exam ined by conventional ultrasound(two-dimensional gray-scale ultrasound and Doppler ultrasound)in our hospital.Before the examination,the patient must be informed of the possible risks and clinical effects of ultrasound contrast,and the informed consent of the patient must be guaranteed and signed(Annex ?).First,the focus was examined by conventional ultrasound,and the location,size,shape,edge,boundary,aspect ratio,internal echo,calcification,size,distribution and acoustic shadow of calcific ation,attenuation of echo,blood flow signal and abnormality of axillary lymph node metastasis were observed The second score was given to the same focus by intravenous injection of ultrasound microbubble contrast agent,and the second score was given to the same focus by observing whether there was enhancement,the distribution of contrast agent,enhancement degree,enhancement area and the mode of enhancement of the same focus,the third score was given to the same focus by combination of the two examina tions.The evaluation criteria of this study are: the user-defined benign index is 0,and the malignant index is 1.All the indexes listed in the evaluation criteria of this study are statistically significant.Taking the final pathological results as the gold standard,the receiver operating characteristic curve(ROC Curve)was constructed to compare the accuracy of the independent scoring method of conventional ultrasound,contrast-enhanced ultrasound and the combined scoring method for the differentiatio n of benign and malignant BI-RADS4 lesions,as well as the feasibility of establishing the corresponding scoring system.Results: Pathological results were the gold standard in 60 BI-RADS4 lesions.A total of 59 patients,all female,aged 18-78 years,with an average age of(50.42 ± 11.11)years.There were 60 lesions in total,31 in the left breast and 29 in the right breast,the maximum diameter of the lesions was 7-51 mm,with an average of(19.87 ± 8.78)mm.The postoperative pathological results showed that there were 28 benign and 32 malignant lesions.The results showed that the shape(regular or irregular),boundary(clear or unclear),aspect ratio(> 1 or ? 1),internal echo(even or uneven),gritty calcification(with or without)and posterior echo(attenuated or not),internal and peripheral blood flow signals(with or without),axillary lymph nodes(without abnormality or size,shape,structure)were normal The main indexes of conventional ultrasound diagnosis.Whether there is enhancement(with or without pathological blood vessels),distribution(even or uneven),enhanced intensity(high or low),enhanced area(no increase or increase),and enhancement mode(fast or slow)are the main indexes of ultrasound contrast diagnosis.The above observation contents All of them are the main indexes for the diagnosis of breast lesions by conventional ultrasound combined with contrast-enhanced ultrasound.According to the ROC curve,we can infer that the conventional ultrasound score 4.5 is the diagnostic crit ical point,the area under the curve(AUC)is 0.898,the sensitivity is 75.0%,the specificity is 96.4%,and the accuracy is 85.0%.The contrast-enhanced ultrasound score 2.5 is the diagnostic critical point,the area under the curve(AUC)is 0.933,the se nsitivity is 87.5%,the specificity is 89.3%,and the accuracy is 88.3%.The combined ultrasound and contrast-enhanced ultrasound score 5.5 is the diagnostic critical point,and the AUC is 0.951,Sensitivity 90.6%,specificity 85.7%,accuracy 88.3%.The se nsitivity of the two combined scoring methods were higher than that of the single scoring method,the difference was statistically significant(P < 0.05).Conclusion:(1).The combined scoring method of conventional ultrasound and contrast-enhanced ultrasound can improve the accuracy of differentiation of BI-RADS 4 breast tumors,optimize the classification of breast lesions,and improve the diagnostic confidence.(2).Uneven high enhancement,increased neovascularization and rapid perfusion may be the main re ference indexes for the diagnosis of breast malignant lesions by contrast-enhanced ultrasound.(3).We can establish the corresponding scoring system for breast lesions through the observation indicators of conventional ultrasound and contrast-enhanced ultrasound,and evaluate the benign and malignant breast lesions.