Differentiating Benign from Malignant Solid Breast Lesions: Combined Utility of Conventional Ultrasound and Contrast-enhanced Ultrasound in Comparison with Magnetic Resonance Imaging

Objective: To prospectively evaluate the diagnostic efficacy of conventional ultrasound (US), contrast-enhanced US (CEUS), the combined use of two modalities, and magnetic resonance imaging (MRI) in the differentiation of focal solid breast lesions.

Materials And Methods: 61 patients with BI-RADS category 3-5 breast lesions detected at conventional US underwent CEUS and MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of conventional US, CEUS, combination of two modalities and MRI for discrimination between benign and malignant breast lesions.

Results: Tissue specimens of 61 breast lesions were obtained either from surgical resection (n=46) or from needle biopsy (n=15). Histopathologic diagnosis revealed 28 benign and 33 malignant lesions. The diagnostic performance of conventional US and CEUS in differentiating benign from malignant breast lesions showed no significant difference (P=0.741). The combination of two modalities significantly improved the diagnostic accuracy compared with either conventional US or CEUS alone (P=0.031 and P=0.012, respectively). The area under the ROC curve (A(z)) value for the combined use of two modalities for discrimination between benign and malignant breast lesions was 0.94, and that for MRI was 0.91, whereas no statistical difference was found between them (P=0.296).

Conclusion: The combined use of conventional US and CEUS has a better diagnostic performance than either method alone and displays good agreement with MRI in the differentiation capability for benign and malignant breast lesions.