Contrast-enhanced ultrasound improved performance of breast imaging reporting and data system evaluation of critical breast lesions

Table 1 Final pathological diagnosis of 235 breast lesions and breast imaging reporting and data system after contrast- enhanced ultrasound

Histopathological diagnosis	BI-RADS after CEUS					Total
	3	4A	4B	4C	5
Benign lesions						139
Fibroadenoma	47	3	1	2		53
Fibrocystic mastopathy	34	1				35
Complex sclerosing adenosis	2		2	1		5
Hyperplasia	2	1	1			4
Chronic mastitis	12	5	3		1	21
Granulomatous mastitis	2	1	1			4
Intraductal papilloma	4	2			3	9
Benign phyllodes tumor		2			1	3
Hamartoma	1		1			2
Radial scar	2					2
Bolus material after operation	1					1
Malignant lesions						96
IDC	7	1	3	5	62	78
DCIS	2	1		3	3	9
Mucinous carcinoma		2			1	3
Infiltrating lobular carcinoma					2	2
Diffused large B-cell lymphoma		1	1			2
Malignant phyllodes tumor				1		1
Solid neuroendocrine carcinoma					1	1
Total						235

IDC: Invasive ductal carcinoma; DCIS: Ductal carcinoma in suit; BI-RADS: Breast lesions and breast imaging reporting and data system; CEUS: Contrast- enhanced ultrasound.

Table 2 Enhancement patterns of invasive malignant tumors classified as breast lesions and breast imaging reporting and data system S 3

No.	Size (mm)	LN	Histology	Mammography
1	18 × 15	Negative	IDC (triple negative)	Hyperplasia fibrocystic
2	14.6 × 10.7	Negative	IDC (triple negative)	Mastopathy
3	12 × 8	Negative	IDC (HER2)	Solid lesion
4	19 × 15	Negative	Mixed mucinous carcinoma(Luminal A)	Hyperplasia
5	25 × 17	Negative	IDC (triple negative)	Phyllodes tumor
6	30 × 15	Positive	IDC (triple negative)	Solid lesion
7	30 × 25	Negative	IDC (Luminal B)	Without
8	18.8 × 15.7	Negative	IDC (triple negative)	Solid lesion
9	38 × 37	Negative	Diffused B-cell lymphoma	Without
10	11 × 10	Negative	Mucinous carcinoma	Without
11	17 × 14	Negative	Mucinous carcinoma	Adenoma

IDC: Invasive ductal carcinoma; LN: Lymph node.

Table 3 Enhancement patterns of invasive malignant tumors classified as breast lesions and breast imaging reporting and data system S 4A (false negative lesions)

No.	Enhancement patterns
	Time	Intensity	Scope after enhancement	Direction	Craw-like pattern	Nourishing vessel	Shape after enhancement
1	Rapid	Hyper	Equal	Complex	Absent	Absent	Regular
2	Synchronous	Iso	Equal	Complex	Absent	Absent	Irregular
3	Rapid	Hyper	Smaller	Centripetal	Absent	Absent	Regular
4	Rapid	Hyper	Equal	Complex	Absent	Absent	Regular
5	Rapid	Hyper	Equal	Centripetal	Absent	Absent	Regular
6	Rapid	Hyper	Larger	Complex	Absent	Present	Regular
7	Rapid	Hyper	Larger	Complex	Absent	Absent	Irregular
8	Synchronous	Hyper	Equal	Complex	Absent	Absent	Regular
9	Slow	Hypo	Equal	Centripetal	Absent	Absent	Regular
10	Rapid	Hyper	Smaller	Complex	Absent	Present	Irregular
11	Slow	Hypo	Smaller	Centripetal	Absent	Absent	Regular

Table 4 The effect of increasing biopsy thresholds on biopsy rates, cancer-to-biopsy yields, and malignancies missed

BI-RADS category	Biopsy rate (%)	Invasive cancers recommended for 6 mo follow-up (%)	Cancer-to-biopsy yield (%)
If biopsy performed on all BI-RADS4 lesions	235 (100)	0 (0)	96/235 (40.85)
> BI-RADS 3 (2%-94%)	119 (50.64)	7 (2.98)	87/119 (73.11)
> BI-RADS 4A (10%-94%)	99 (42.13)	11 (4.68)	82/99 (82.83)
> BI-RADS 4B (50%-94%)	86 (36.60)	15 (7.66)	78/86 (90.70)
> BI-RADS 4C (95%-100%)	74 (31.49)	21 (9.79)	69/74 (93.24)

Unless otherwise stated, data are the number of lesions with percentages in parentheses, the denominator is 235 lesions for all percentages except for the positive predictive value of the cancer to biopsy yield. BI-RADS: Breast imaging reporting and data system.