Contrast-enhanced ultrasound is helpful in the differentiation of malignant and benign breast lesions

Zhao, Hongjia; Xu, Rong; Ouyang, Qiufang; Chen, Lidian; Dong, Baowei; Huihua, Ye

doi:10.1016/j.ejrad.2009.05.043

« Previous Next »European Journal of Radiology
Volume 73, Issue 2 , Pages 288-293, February 2010

Contrast-enhanced ultrasound is helpful in the differentiation of malignant and benign breast lesions

Hongjia Zhao
- Department of Ultrasound, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
Rong Xu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
Qiufang Ouyang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
Lidian Chen
- Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Corresponding author. Tel.: +86 591 22861985; fax: +86 591 22861989.
Baowei Dong
- Department of Ultrasound, PLA 301 General Hospital, Beijing, China
Ye Huihua
- Department of Ultrasound, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China

Received 29 December 2008; received in revised form 20 May 2009; accepted 26 May 2009.

Abstract

Objective

To evaluate the significance of contrast-enhanced ultrasound (CEUS) examination in differential diagnosis of malignant and benign breast lesions.

Methods

Seventy-one patients with seventy-six breast tumors are selected randomly. CEUS examinations were performed before and after bolus injection of the contrast agent SonoVue (Bracco, Milan, Italy). Specific sonographic quantification software, Qontrast, was adopted to determine the morphology of vessels. Wash-in and wash-out parameters of each lesion were assessed for both procedures.

Results

The final histopathological findings distinguished 45 malignant and 31 benign from all of the lesions. Following SonoVue administration different perfusion phases could be identified: early (0–1min), mid (1–4min) and late (4–6min) phases. In the early phase, CEUS identified 91.1% of malignant tumors characterized by a claw-shaped enhancement, while 83.9% of benign tumors had a homogeneous enhancement, with a statistically significant difference between the two enhancement patterns (χ²=43.16, P<0.01). Moreover, contrast medium persistence in the late phase was helpful in the identification of benign and malignant tumors (χ²=46.88, P<0.01): contrast medium was present in 88.9% of malignant tumors, while in only 9.7% of the benign tumors. The study showed that various parametric imaging color maps for peak intensity and time to peak were mostly suggestive of malignancy, while quite uniform peak intensity and time to peak of color maps were the characteristic of benign tumors. The study also found that malignant lesions presented with a higher maximum intensity signal than benign ones (P<0.05) on the time–intensity curves.

Conclusions

CEUS cooperating with conventional US shows improved accuracy in differentiating between malignant and benign breast tumors. It could be a reliable diagnostic method of breast lesions.

Keywords: Contrast-enhanced ultrasound, Breast neoplasm, Qontrast software, Time–intensity curve