Time Difference of Arrival on Contrast-Enhanced Ultrasound in Distinguishing the Benign and Malignant Peripheral Pulmonary Lesions

Abstract

Background: The incidence and mortality of lung cancer are the highest in the world, and the most lesions are located in lung periphery. Despite the greatest degree of screening and diagnosis, the pathologic types of peripheral pulmonary lesions (PPLs) are difficult to diagnose by noninvasive examination. Here, we found a novel index time difference of arrival (TDOA) to discriminate between benign and malignant lesions of PPLs. Methods: We retrospectively analyzed 96 patients with PPLs using the contrast-enhanced ultrasound (CEUS), who had undergone biopsy to confirm the pathologic types. All the data collected from Dazhou Central Hospital between December 2012 and July 2019. The parameters of CEUS analyzed by two assistant chief physicians of ultrasound diagnosis. Area under the receiver operating characteristic curve analysis, sensitivity, specificity, positive predictive value and negative predictive value were performed to assess the diagnostic ability of different indices. Findings: We found that the TDOA significantly distinguished benign from malignant lesions. The TDOA was markedly increased in patients with malignant lesions than benign lesions (P<0*001). Compared with conventional time-intensity curve (TIC) indices, the TDOA showed high diagnostic accuracy (area under the curve, 0*894). Moreover, conventional diagnostic indices did not affect the diagnostic performance of TDOA by adjusted the receiver operating characteristic curve. Interpretation: Our results suggest that the TDOA is feasible for the diagnosis of the patients with PPLs. Funding Statement: This article was funded by the National Natural Science Foundation of China (81902861), the Scientific Research Fund of Sichuan health and Health Committee (No. 18PJ361) and the Scientific Research Fund of Technology Bureau in Sichuan Province (No. 2018138, No. 2018JY0324). Declaration of Interests: All authors declare no competing interests of this study. Ethics Approval Statement: The study was approved by the Ethics Committee of Dazhou Central Hospital, Sichuan, China.