Study on Contrast-Enhanced Ultrasound Combined with Serology in Optimizing the Diagnosis of BI-RADS Category 4 Nodules

Jiao Lu; Meixin Huang; Shitang Nong; Chengcai Chen; Ting Huang

doi:10.54097/4t7enk56

Authors

Jiao Lu
Meixin Huang
Shitang Nong
Chengcai Chen
Ting Huang

DOI:

https://doi.org/10.54097/4t7enk56

Keywords:

Contrast-Enhanced Ultrasound (CEUS), BI-RADS Category 4 Nodules, Breast Cancer, Serological Indicators, Diagnostic Efficacy

Abstract

Objective: Taking pathological results as the gold standard, this study aimed to analyze the clinical application value of contrast-enhanced ultrasound (CEUS) qualitative features combined with carbohydrate antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA) in improving the diagnostic efficacy for breast imaging reporting and data system (BI-RADS) Category 4 nodules. Methods: A retrospective analysis was conducted on 308 cases of breast BI-RADS Category 4 nodules with pathological results, diagnosed in the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2022 to November 2024. These cases were divided into a malignant group (111 cases) and a benign group (197 cases). The nodules were reclassified according to BI-RADS based on CEUS qualitative features and serological indicators. Receiver operating characteristic (ROC) curves were constructed to compare the differences in diagnostic efficacy between single diagnostic methods and combined diagnostic methods for breast BI-RADS Category 4 nodules. Results: Statistically significant differences were observed between the benign and malignant groups of breast BI-RADS Category 4 nodules in terms of CEUS qualitative features, including enhancement intensity, uniformity of contrast agent distribution, perfusion defect, post-enhancement boundary, enhancement range, and radial convergence (all P<0.05). The levels of CEA, CA15-3, and age in the malignant group were higher than those in the benign group, with statistically significant differences (all P<0.05). Among the indicators, enhancement pattern, post-enhancement boundary, enhancement range, radial convergence, age, and CA15-3 showed relatively better diagnostic efficacy; the combined diagnostic efficacy of these six indicators was the highest, with an area under the curve (AUC) of 0.948, sensitivity of 92.8%, and specificity of 86.3% (95% confidence interval [CI]: 0.924-0.972). Conclusion: The combination of CEUS qualitative features and serological indicators can improve the diagnostic efficacy for breast BI-RADS Category 4 nodules.

Downloads

Download data is not yet available.

References

[1] Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants [J]. Chin Med J (Engl), 2022, 135(5): 584-590.

[2] Lei S, Zheng R, Zhang S, et al. Breast cancer incidence and mortality in women in China: temporal trends and projections to 2030 [J]. Cancer Biol Med, 2021, 18(3): 900-909.

[3] Shi Z, Lin J, Wu Y, et al. Burden of cancer and changing cancer spectrum among older adults in China: trends and projections to 2030 [J]. Cancer Epidemiol, 2022, 76: 102068.

[4] Yuan Y, Xu M, Ren Y, et al. Clinical value of contrast-enhanced ultrasound in breast cancer diagnosis [J]. Comput Math Methods Med, 2022, 2022: 2017026.

[5] Ryu J, Kang D, Cho J, et al. Prognostic impact of elevation of cancer antigen 15-3 (CA15-3) in patients with early breast cancer with normal serum CA15-3 level [J]. J Breast Cancer, 2023, 26(2): 126-135.

[6] Han L, Zhang H, Ma Q. Relationship between MRI ADC values, pathological parameters, and serum tumor markers in breast cancer patients [J]. Chin J CT MRI, 2023, 21(5): 76-78. (In Chinese)

[7] American College of Radiology. Breast Imaging Reporting and Data System (BI-RADS) atlas [M]. 5th ed. Reston, VA: American College of Radiology; 2013.

[8] Shi Y, Yin P, Gu X, et al. Study on establishing a quantitative scoring system for ultrasound BI-RADS classification of breast nodules based on genetic algorithm [J]. J Chin Ultrasound Med, 2022, 38(11): 1221-1225. (In Chinese)

[9] Li L, Xu Y, Lai Z, et al. Development and validation of a model and nomogram for breast cancer diagnosis based on quantitative analysis of serum disease-specific haptoglobin N-glycosylation [J]. J Transl Med, 2024, 22(1): 331.

[10] Sidhu P, Cantisani V, Dietrich C, et al. The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version) [J]. Ultraschall Med, 2018, 39(2): e2-e44.

[11] Li H, Feng X, Wang J, et al. Research progress in acute anticoagulation therapy for cerebral infarction [J]. Minerva Pediatr (Torino), 2023, 75(6): 939-942.

[12] Zuo W, Jin L, Liu X, et al. Diagnostic value of microvascular imaging combined with contrast-enhanced ultrasound 5-point method for BI-RADS category 4 breast masses [J]. J Chin Ultrasound Med, 2021, 37(9): 974-978. (In Chinese)

[13] Guo R, Lu G, Qin B, et al. Ultrasound imaging technologies for breast cancer detection and management: a review [J]. Ultrasound Med Biol, 2018, 44(1): 37-70.

[14] Le T, Luo J, Wu H, et al. Contrast-enhanced ultrasound manifestations and misdiagnosis analysis of breast inflammatory lesions [J]. J Clin Ultrasound Med, 2019, 21(1): 55-58. (In Chinese)