The Diagnostic Value Of Contrast-enhanced Ultrasound In Differentiating Breast Lesions Of BI-RADS 4B

Objective:This study aimed to explore the diagnostic and clinical value of contrast-enhanced ultrasound in the diagnosis of benign and malignant breast lesions of BI-RADS 4B and provide support for the application of contrast-enhanced ultrasonography in the differentiation of breast tumor.The secondary aim was to analysis the reason of misdiagnosis and reduce the occurrence of misdiagnosis and increase the coincidence rate.Methods:Between September 2017 and September 2019,a total of 89 patients with BI-RADS 4B breast masses(95 cases of breast masses)underwent contrast-enhanced ultrasound examination in the department of ultrasound medicine of liaoning provincial people's hospital.All the masses had pathological diagnosis results.Using Siemens S3000 ultrasonic diagnostic instrument and equipped with 9L4 linear array probe.Firstly,a two-dimensional ultrasound model was selected to observe the size,position,shape,edge,echo characteristics inside and behind the tumor,calcification,blood flow distribution and spectral characteristics of the tumor.All patients signed informed consents prior to CEUS.During the examination,ask the patient to remain in the same position and breathe calmly.The pressure of the probe is moderate and stable,and the probe is always in the same section.The CEUS process is real-time and dynamic video storage,continuous observation for 3min,image storage,and results analysis.Each patient was examined by the same senior chief physician at CEUS and the imaging data were recorded and preserved.Another senior chief physician analyzed and recorded the morphological and quantitative indicators of each lesion under contrast-enhanced ultrasound,and re-classified the lesion.The parameters were collated and the pathological results were recorded by a physician assistant.All the masses was divided into begin group or malignant group.Morphologic characteristics was described by count data and the difference between groups was compared by Chi-square test;Quantitative parameters was described by measurement data and the difference between groups was compared by Student's t-test,Significant differences were found between benign and malignant lesions in qualitative and quantitative indexes of CEUS(P< 0.05).Results:All of the 89 patients were females(52.1±7.5 years),range 21-87 years.The diameter of the lesions of 95 breast masses ranged from 4 to 32 mm,with an average of(12.3±4.7)mm.There were 43 cases of biopsy,52 cases of surgical resection.Finally,44 benign lesions and 51 malignant lesions were obtained.The diagnostic accuracy of BI-RADS4 B nodules by conventional ultrasound was 62.8%.CEUS had a sensitivity of 88.2%,specificity of 63.6%,positive predictive value of 73.8%,negative predictive value of82.4%,and accuracy of 76.8% for the diagnosis of BI-RADS 4B nodules.Among the morphological indicators of contrast-enhanced ultrasound of breast tumors,enhanced intensity,enhanced area,lesion margin,lesion shape,internal echo,and peripheral blood vessels are of significance for the differential diagnosis of benign and malignant BI-RADS 4B nodules.Among the quantified indicators of contrast-enhanced ultrasound of breast tumors,quantitative indicators such as peak intensity and area under the curve are of significance for the differential diagnosis of benign and malignant BI-RADS 4B nodules.Conclusion:1.The atypical manifestation of benign lesions is the main cause of false-positive ultrasonographic diagnosis of BI-RADS 4B tumors in the breast.2.Contrast-enhanced ultrasound is helpful for further differential diagnosis of benign and malignant BI-RADS 4B tumors.3.Enhanced intensity,enhanced area,lesion edge,lesion shape,internal echo,peripheral blood vessels and other morphological indicators and peak intensity,area under the curve and other quantitative indicators can provide valuable information for the further differential diagnosis of benign and malignant breast tumors.