Abstract
The new application of contrast-enhanced ultrasonography (CEUS) in the diagnosis of breast masses has evolved quickly only in recent years. Nevertheless, mixed results owing to the overlap in characteristics of benign and malignant lesions are simultaneously discovered by most studies, partially attributed to different histopathologic characteristics of breast cancer. To explore the characteristics of different histopathologic types of breast cancer at real-time gray-scale CEUS and evaluate its diagnostic value. One hundred and one histopathologically confirmed malignant lesions were included. We retrospectively reviewed the contrast-enhanced ultrasonographic findings including morphologic features, quantitative parameters, and correlated them with histopathology. True-positive rate was calculated to assess the diagnostic performance of CEUS. The 101 malignancies displayed irregular shape (72 [71%]), poorly-defined margin (73 [72%]), penetrating or tortuous surrounding vessels (79 [78%]), heterogeneous enhancement (84 [83%]), including focal perfusion defects (24 [24%]). For each histopathologic type, 87% (58/67) of invasive ductal carcinoma (IDC) showed heterogeneous enhancement. Of all the 24 perfusion defects, IDC account for 88% (21/24). Low average peak intensity (PI) of 4.9 was detected in this type. Ductal carcinoma in situ (DCIS) excellently showed the features of irregular shape (82% [14/17]), poorly-defined margin (82% [14/17]), heterogeneous enhancement (94% [16/17]). While 83% (5/6) of medullary carcinoma exhibited regular shape, well-defined margin, homogenous enhancement, and high average PI value of 9.6. Invasive lobular carcinoma showed similar enhancement pattern to that of IDC. Intraductal papillary carcinoma displayed high average PI value of 8.1. The overall true-positive rate for conventional US and CEUS was 88%, 86%, respectively. DCIS, medullary carcinoma, and intraductal papillary carcinoma achieved an improved true-positive rate (94%, 100% and 100%, respectively). The imaging characteristics of CEUS are variable in different histopathologic types of breast cancer. CEUS does not appear to be superior to conventional ultrasound as a diagnostic tool overall, however, it is a useful adjunct to conventional ultrasound in diagnosing some special types of breast cancer.
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