Can Ultrasound Elastography Help Better Manage Mammographic BI-RADS Category 4 Breast Lesions?

作者：Gu, Yang; Tian, Jiawei; Ran, Haitao; Ren, Weidong; Chang, Cai; Yuan, Jianjun; Kang, Chunsong; Deng, Youbin; Wang, Hui; Luo, Baoming; Guo, Shenglan; Zhou, Qi; Xue, Ensheng; Zhan, Weiwei; Zhou, Qing; Li, Jie; Zhou, Ping; Zhang, Chunquan; Chen, Man; Gu, Ying; Xu, Jinfeng; Chen, Wu; Zhang, Yuhong; Li, Jianchu; Wang, Hongyan^*; Jiang, Yuxin^*

来源：Clinical Breast Cancer, 2022, 22(4): E407-E416.

DOI：10.1016/j.clbc.2021.10.009

• Breast classification
• Breast neoplasms
• Mammography
• Ultrasonography
• Diagnostic performance

We assessed the performance of conventional ultrasound (US) combined with strain elastography (SE) in the Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions on mammography. A total of 751 women with 751 breast lesions classified as mammographic BI-RADS category 4 were included. Conventional US combined with SE helped increase the PPV and had the potential to avoid unnecessary biopsies of BI-RADS category 4 lesions detected on mammography. @@@ Background: To assess the performance of conventional ultrasound (US) combined with strain elastography (SE) in the Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions on mammography. Materials and Methods: Women with breast lesions identified as having mammography BI-RADS 4 lesions and underwent US examination were included in China. US features and US BI-RADS assessment were recorded in real-time and prospectively reported. The pathological result was referred to as the gold standard. The performance of US in the mammographic BI-RADS category 4 lesions was evaluated. Diagnostic performances of US BI-RADS, SE and combined both were compared. Results: A total of 751 women with 751 breast lesions classified as mammographic BI-RADS category 4 were included. For mammographic findings, 530 (70.6%) were true positive and 221 (29.4%) were false positive. Conventional US achieved higher positive predictive value (PPV) than mammography (78.5% vs. 70.6%, P=.001). The specificity increased from 34.4% to 47.1% (P < . .001) without any loss in sensitivity and the PPV increased to 81.9% (P = .122) when conventional US was used in combination with SE. For conventional US combined with SE, it led to a correct diagnosis of no breast cancer in 104 of the 221 false-positive findings (47.1%) and achieved higher PPV than mammography regardless of patient age and lesion size. Conclusion: Conventional US combined with SE is a helpful tool for the noninvasive examination of breast lesions classified as BI-RADS category 4 on mammography. It helped increase the PPV and had the potential to avoid unnecessary biopsies of BI-RADS category 4 lesions detected on mammography.

• 单位
  中山大学; 1; 哈尔滨医科大学; 复旦大学; 吉林大学; 华中科技大学; 中国医学科学院; 中国医学科学院北京协和医院; 武汉大学; 中国医科大学; 西安交通大学; 上海交通大学; 南昌大学; 山东大学