Provisional results of contrast-enhanced ultrasonography of breast tumors (JABTS FLOW-CEUS01 study -part 1-)

Abstract

Background Contrast-enhanced ultrasonography (CEUS) of the breast with perflubutane (Sonazoid®) was conducted for detecting mammary tumors and expanded in August 2012. This study shows typical images of benign and malignant tumors; however, these images are now out-of-date owing to performance improvements in ultrasonic devices. Therefore, Flow Imaging Research Group, the Japan Association of Breast and Thyroid Sonology (JABTS), examined the contrast pattern of benign and malignant tumors using CEUS (JABTS FLOW-CEUS01, UMINID: 000026289). Purpose The JABTS FLOW-CEUS01 multicenter study aims to select typical CEUS images of benign and malignant tumors and reevaluate diagnostic criteria based on this data. We first present diagnostic criteria based on extracted educational cases. Materials and Methods Two hundred and eighteen breast tumors from nine institutions that have performed CEUS with perflubutane (Sonazoid®) followed by histological examinations were used in this study. After evaluating 30 educational cases extracted from among all registered cases, we proposed CEUS findings and criteria for differential diagnosis between benign and malignant breast tumors. The remaining 188 cases were used for diagnosing sets diagnosed by three blind readers. Based on the new findings and criteria, the diagnostic accuracy of CEUS of breast tumors was evaluated. This study was approved by the Ethics Committee and institutional review board of Toho University Omori Medical Center. Results As CEUS findings for differential diagnosis, five contrast-enhancement patterns (shapes, margins, defects of stains, intensity, and homogeneity), three vascular patterns (tree-like appearance, surrounding marginal vessels, plunging or penetrating vessels), and a range of contrast-enhanced areas were selected. These nine findings were adopted as criteria in this study.