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A multicenter study of a contrast-enhanced ultrasound diagnostic classification of breast lesions

Authors Tang L, Chen Y, Du Z, Zhong Z, Chen Q, Yang L, Shen R, Cheng Y, Zhang Z, Han E, Lv Z, Yuan L, Yang Y, Cheng Y, Yang L, Wang S, Bai B, Luo J

Received 21 November 2018

Accepted for publication 6 February 2019

Published 15 March 2019 Volume 2019:11 Pages 2163—2170


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Chien-Feng Li

Lina Tang,1,* Yijie Chen,1,* Zhongshi Du,1 Zhaoming Zhong,1 Qin Chen,2 Lichun Yang,3 Ruoxia Shen,3 Yan Cheng,4 Zizhen Zhang,4 Ehui Han,5 Zhihong Lv,5 Lijun Yuan,6 Yong Yang,6 Yinrong Cheng,7 Lei Yang,7 Shengli Wang,8 Baoyan Bai,8 Jun Luo2

1Department of Ultrasound, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou 350014, Fujian Province, China; 2Department of Ultrasound, Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China; 3Department of Ultrasound, The Third Affiliated Hospital of Kunming Medical University and Yunnan Cancer Hospital, Kunming 650118, Yunnan Province, China; 4Department of Ultrasound, Qujing City First People’s Hospital, Qujing 655000, Yunnan Province, China; 5Department of Ultrasound, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi 435000, Hubei Province, China; 6Department of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi’an 710032, Shanxi Province, China; 7Department of Ultrasound, Chengdu First People’s Hospital, Chengdu 610000, Sichuan Province, China; 8Department of Ultrasound, Yanan University Affiliated Hospital, Yan’an 716000, Shanxi Province, China

*These authors contributed equally to this work

Purpose: To evaluate a classification model of contrast-enhanced ultrasound (CEUS) and examine the characteristics of patients with false-negative diagnosis.
Patients and methods: A retrospective secondary analysis of a multicenter trial of CEUS for breast cancer diagnosis (from August 2015 to April 2017) was undertaken. Patients (n=1,023) with Breast Imaging Reporting and Data System 4–5 lesions on B-mode ultrasound underwent CEUS. Pathological diagnoses were available from surgical or biopsy specimens for correlation. Lesion maximum diameter (LMD), distance to the papilla (DtP), distance from the superficial edge of the lesion to the skin (DtS), distance from the deep edge of the lesion to the pectoralis muscle (DtPM), and body mass index (BMI) were evaluated.
Results: Median age and BMI were 48.0 and 41.2 years and 23.2 and 22.4 kg/m2 for patients with malignant and benign lesions, respectively. Overall sensitivity, specificity, and accuracy of CEUS for malignancy were 89.4%, 65.3%, and 75.8%, respectively. The patients with true-positive and false-negative diagnosis (ie, with malignant lesion) were older than those with false-positive and true-negative diagnosis (ie, with benign lesion). Patients with true-positive and false-positive diagnoses had higher BMI than patients with true-negative and false-negative diagnoses (P=0.004). Patients with true-positive and false-negative diagnoses had larger LMD and DtP, as well as smaller DtS and DtPM.
Conclusion: Older age, higher BMI, larger LMD and DtP, and smaller DtS and DtPM were associated with malignant lesions on CEUS. Patients with these characteristics should undergo further imaging.

Keywords: breast cancer, ultrasound, contrast-enhanced ultrasound

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