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

Figures & data

Figure 1 Measurement of the distance to the papilla (DtP). The distance shown in the figure is 1.17 cm.

Figure 2 Measurement of the distance from the superficial edge of the lesion to the skin (DtS) and the distance from the deep edge of the lesion to the pectoralis muscle (DtPM).

Note: The distances shown in the figure are DtS =0.752 cm and DtPM =0.191 cm.

Figure 3 The benign sub-models of contrast-enhanced ultrasound for breast lesions. (A) Rapid wash-in with hyper-enhancement and clear margin after enhancement without enlarged size. (B) Synchronous or slow wash-in with iso-enhancement, and no difference in margin and shape after enhancement. (C) Synchronous or slow wash-in with hypo-enhancement.

Figure 4 The malignant sub-models of contrast-enhanced ultrasound for breast lesions.

Notes: (A) Hyper-enhancement with enlarged range, with or without irregular shape. (B) Hyper-centripetal enhancement with perfusion defect, with or without enlarged range. (C) Rapid or synchronous wash-in with hyper- or iso-enhancement, presenting penetrating vessels (as indicated by the white arrows) or crab claw-like pattern, with or without perfusion defect.

Table 1 Characteristics of the patients and lesions

Variables	All, n (%)	Malignant CEUS, n (%)	Benign CEUS, n (%)	Malignant and benign CEUSa, n (%)
No (lesions)	1,023	579	425	19
Age (years)
Median (range)	44.7 (18-81)
<35	203 (19.8)	83 (40.9)	118 (58.1)	2 (1.0)
>35	820 (80.2)	496 (60.5)	307 (37.4)	17 (2.1)
Body mass index (kg/m^2)
Median (range)	22.9 (14.7-50.8)
<25.0	803 (78.5)	435 (54.2)	352 (43.8)	16 (2.0)
>25.0-29.9	197 (19.3)	130 (66.0)	64 (32.5)	3 (1.5)
>30.0	23 (2.2)	14 (60.9)	9 (39.1)	0
Histopathology
Benign lesions (n=579)
Fibroadenoma	254 (43.9)	71 (28.0)	179 (70.5)	4 (1.6)
Fibrocystic mastopathy	132 (22.8)	39 (29.5)	91 (68.9)	2 (1.5)
Complex sclerosing adenosis	15 (2.6)	9 (60.0)	5 (33.3)	1 (6.7)
Hyperplasia	72 (12.4)	16 (22.2)	56 (77.8)	0
Atypical hyperplasia	11 (1.9)	8 (72.7)	3 (27.3)	0
Granulomatous mastitis	43 (7.4)	30 (69.8)	12 (27.9)	1 (2.3)
Intraductal papilloma	42 (7.3)	13 (31.0)	25 (59.5)	4 (9.5)
Benign phyllodes tumor	9 (1.6)	3 (33.3)	6 (66.7)	0
Hamartoma	1 (0.2)	0	1 (100)	0
Malignant lesions (n=444)
IDC	389 (87.6)	347 (89.2)	37 (9.5)	5 (1.3)
DCIS	32 (7.2)	30 (93.8)	2 (6.3)	0
Mucinous carcinoma	11 (2.5)	7 (63.6)	2 (18.2)	2 (1.8)
Infiltrating lobular carcinoma	4 (0.9)	3 (75.0)	1 (25.0)	0
Diffused large B-cell lymphoma	1 (0.2)	0	1 (100)	0
Malignant phyllodes tumor	3 (0.7)	2 (66.7)	1 (33.3)	0
Solid neuroendocrine carcinoma	1 (0.2)	1 (100)	0	0
Sarcoma	3 (0.7)	0	3 (100)	0

Note:

a The lesions that met both benign and malignant classes were categorized as malignant.

Abbreviations: DCIS, ductal carcinoma in situ; IDC, invasive ductal carcinoma.

Table 2 Characteristics of the patients according to the type of final diagnosis

Factors	True positive (n=397)	True negative (n=378)	False positive (n=201)	False negative (n=47)	P-value
Age (years)	49.5 (23–81)	41.2 (18–70)a	41.2 (20–72)b	47.2 (18–79)e,f	<0.05
Body mass index (kg/m^2)	23.11 (14.7–50.8)	22.47 (16.0–43.9)a	23.29 (16.9–37.6)c	22.4 (16.5–31.2)	0.004
Lesion maximum diameter (mm)	23.35 (5.0–75.5)	14.78 (4.0–55.8)a	17.06 (4-85)b,d	19.63 (6.2–43.6)d	<0.05
Distance to the papilla	26.31 (0–89)	20.36 (0–66)a	23.13 (0–76)	26.51 (0–80)	<0.05
Superficial edge of the lesion to the skin	5.86 (0–28)	6.46 (0–23)a	6.80 (0.30–23.0)b	4.84 (1–10)e,f	<0.05
Distance from the deep edge of the lesion to the pectoralis muscle	2.41 (0–32)	3.75 (0–28)a	4.35 (0–31.8)b	3.42 (0–13)	<0.05

Notes: All data are shown as median (range).

a True positive vs true negative, P<0.05.

b True positive vs false positive, P<0.05.

c True negative vs false positive, P<0.05.

d True negative vs false negative, P<0.05.

e True positive vs false negative, P<0.05.

f False positive vs false negative, P<0.05.