Assessment of Additional MRI-Detected Breast Lesions Using the Quantitative Analysis of Contrast-Enhanced Ultrasound Scans and Its Comparability with Dynamic Contrast-Enhanced MRI Findings of the Breast

다국어 초록 (Multilingual Abstract)

Purpose To assess the diagnostic performance of contrast-enhanced ultrasound (CEUS) for additional MR-detected enhancing lesions and to determine whether or not kinetic pattern results comparable to dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of the breast can be obtained using the quantitative analysis of CEUS.
Materials and Methods In this single-center prospective study, a total of 71 additional MR-detected breast lesions were included. CEUS examination was performed, and lesions were categorized according to the Breast Imaging-Reporting and Data System (BI-RADS). The sensitivity, specificity, and diagnostic accuracy of CEUS were calculated by comparing the BI-RADS category to the final pathology results. The degree of agreement between CEUS and DCE-MRI kinetic patterns was evaluated using weighted kappa.
Results On CEUS, 46 lesions were assigned as BI-RADS category 4B, 4C, or 5, while 25 lesions category 3 or 4A. The diagnostic performance of CEUS for enhancing lesions on DCE-MRI was excellent, with 84.9% sensitivity, 94.4% specificity, and 97.8% positive predictive value. A total of 57/71 (80%) lesions had correlating kinetic patterns and showed good agreement (weighted kappa = 0.66) between CEUS and DCE-MRI. Benign lesions showed excellent agreement (weighted kappa = 0.84), and invasive ductal carcinoma (IDC) showed good agreement (weighted kappa = 0.69).
Conclusion The diagnostic performance of CEUS for additional MR-detected breast lesions was excellent.
Accurate kinetic pattern assessment, fairly comparable to DCE-MRI, can be obtained for benign and IDC lesions using CEUS.

참고문헌 (Reference)

1 Cohen J, "Weighted kappa : nominal scale agreement with provision for scaled disagreement or partial credit" 70 : 213-220, 1968

2 Wang Z, "Tumor size of breast invasive ductal cancer measured with contrast-enhanced ultrasound predicts regional lymph node metastasis and N stage" 7 : 6985-6991, 2014

3 Sridharan A, "Quantitative nonlinear contrast-enhanced ultrasound of the breast" 207 : 274-281, 2016

4 Jansen SA, "Pure ductal carcinoma in situ : kinetic and morphologic MR characteristics compared with mammographic appearance and nuclear grade" 245 : 684-691, 2007

5 Moon WK, "Nonpalpable breast lesions : evaluation with power Doppler US and a microbubble contrast agent-initial experience" 217 : 240-246, 2000

6 Orel SG, "MR imaging of the breast for the detection, diagnosis, and staging of breast cancer" 220 : 13-30, 2001

7 Nykänen A, "Is there a role for contrast-enhanced ultrasound in the detection and biopsy of MRI only visible breast lesions?" 51 : 386-392, 2017

8 Sun F, "Intravesical contrast-enhanced ultrasound (CEUS) for the diagnosis of vesicouterine fistula (VUF): a case report" 97 : e0478-, 2018

9 Tuncbilek N, "Evaluation of tumor angiogenesis with contrast-enhanced dynamic magnetic resonance mammography" 9 : 403-408, 2003

10 Wan C, "Evaluation of breast lesions by contrast enhanced ultrasound : qualitative and quantitative analysis" 81 : e444-, 2012

11 Wan CF, "Enhancement patterns and parameters of breast cancers at contrast-enhanced US : correlation with prognostic factors" 262 : 450-459, 2012

12 Mossa-Basha M, "Ductal carcinoma in situ of the breast : MR imaging findings with histopathologic correlation" 30 : 1673-1687, 2010

13 Du J, "Differentiating benign from malignant solid breast lesions: combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging" 81 : 3890-3899, 2012

14 Spick C, "Diagnostic utility of second-look US for breast lesions identified at MR imaging : systematic review and meta-analysis" 273 : 401-409, 2014

15 Kuhl CK, "Current status of breast MR imaging. Part 2. Clinical applications" 244 : 672-691, 2007

16 Zhao H, "Contrast-enhanced ultrasound is helpful in the differentiation of malignant and benign breast lesions" 73 : 288-293, 2010

17 정용은, "Contrast-enhanced ultrasonography: advance and current status in abdominal imaging" 대한초음파의학회 34 (34): 3-18, 2015

18 Mann RM, "Comparison of enhancement characteristics between invasive lobular carcinoma and invasive ductal carcinoma" 34 : 293-300, 2011

19 Houssami N, "Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging : systematic review and meta-analysis in detection of multifocal and multicentric cancer" 26 : 3248-3258, 2008

20 박아영, "A Prospective Study on the Value of Ultrasound Microflow Assessment to Distinguish Malignant from Benign Solid Breast Masses: Association between Ultrasound Parameters and Histologic Microvessel Densities" 대한영상의학회 20 (20): 759-772, 2019