Re-evaluation of high-risk breast mammography lesions by target ultrasound and ABUS of breast non-mass-like lesions

Jianxing Zhang,Liangping Luo,Jia Liu,Lishang Cai,Dan Yan,Ling Chen,Miao Chen,Xiyan Pang

doi:10.1186/s12880-021-00665-6

Abstract

ObjectiveThe purpose of this study was to reevaluate the high-risk breast non-mass-like lesions (NMLs) in mammography (MG) by target ultrasound (US) and Automated breast ultrasonography (ABUS), and to analyze the correlation between different imaging findings and the factors influencing the classification of lesions.MethodsA total of 161 patients with 166 breast lesions were recruited in this retrospectively study. All cases were diagnosed as BI-RADS 4 or 5 by MG and as NML on ultrasound. While all NMLs underwent mammography, target US and ABUS before breast surgery or biopsy in the consistent position of breast. The imaging and pathological features of all cases were collected. All lesions were classified according to the lexion of ACR BI-RADS®.ResultsThere were significant differences between benign and malignant breast NML in all the features of target US and ABUS. US, especially ABUS, was superior to MG in determining the malignant breast NML. There was a significant difference in the detection rate of calcification between MG and Target US (P < 0.001), and there was a significant difference in the detection rate of structural distortion between ABUS and MG (P < 0.001).ConclusionsTarget US, especially ABUS, can significantly improve the sensitivity, specificity and accuracy of the diagnosis of high-risk NMLs in MG. The features of Target US and ABUS such as blood supply, hyperechogenicity, ductal changes, peripheral changes and coronal features could be employed to predict benign and malignant lesions. The coronal features of ABUS were more sensitive than those of Target HHUS in showing structural abnormalities. Target US was less effective than MG in local micro-calcification.

Highlights

Breast cancer screening and mammography (MG) were considered to be effective methods to reduce breast cancer-related mortality [1, 2], but this will lead to unnecessary biopsy [3], and at least 25% of detectable breast cancer will be missed[4], which included some cases of non-mass-like lesions (NMLs)
NMLs are focal hypoechoic areas found on high-resolution breast ultrasound
For Automated breast ultrasonography (ABUS), the sensitivity, specificity, PPV, NPV and accuracy in determining the malignant breast NML were superior to MG and target US

Summary

Introduction

Breast cancer screening and mammography (MG) were considered to be effective methods to reduce breast cancer-related mortality [1, 2], but this will lead to unnecessary biopsy [3], and at least 25% of detectable breast cancer will be missed[4], which included some cases of non-mass-like lesions (NMLs). NMLs are focal hypoechoic areas found on high-resolution breast ultrasound. Breast ultrasound is considered as an important method to detect and characterize breast lesions[5]. In 2004, the breast and thyroid nosology Association of Japan systematically organized and classified NML. Their criteria included abnormal ductal changes, multi-vesicular patterns, hypo-echoic areas of breast tissue, and structural aberrations[7]

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Discussion

Conclusion