Abstract Objective: To explore the clinical value of automated breast ultrasound system(ABUS) combined with handheld ultrasonography(HHUS) in the differential diagnosis of BI-RADS-US 3~5 among 1 463 cases of benign and malignant breast lesions. Methods: 1 463 breast lesions with BI-RADS 3 followed-up for more than 2 years and BI-RADS 4 and 5 confirmed by surgery or needle biopsy were selected. HHUS and ABUS were performed before operation to obtain 2D images, 3D volume data and the BI-RADS classification. Corresponding to the pathology as the gold standard, ABUS combined with HHUS was used to evaluate the diagnostic efficacy of BI-RADS 3~5 in benign and malignant breast lesions. Results: Among 1 463 cases of breast lesions, 935(63.9%) were benign and 528(36.1%) were malignant. ①According to the ACR version 5 BI-RADS-US classification guidelines, using pathology as the gold standard, the combined diagnostic evaluation of BI-RADS classification and pathological results compared with results by two examination methods(Kappa value=0.85) was higher than that of HHUS(Kappa value=0.81), with statistical significance(P<0.05). Comparing the two methods to assess the risk range of BI-RADS 3~5 categories of malignancy: the probability of 3 type malignancy decreased while the combination of both 0(0) vs. HHUS 0.3%(2/685); 4A type of malignant probability decreased while the two combined 3.4%(5/146) vs. HHUS 13.6%(22/162); 4B malignant probability decreased while the two combined 57.6%(95/165) vs. HHUS 60.1%(98/163); the probability of 4C type of malignancy increased while the combination of the two 84.2%(139/165) vs. HHUS 81.4%(131/161); the probability of 5 type of malignancy increased while the two combined 99.3%(298/291) vs. HHUS 94.2%(275/292). ②The diagnostic efficacy of ABUS combined with HHUS or HHUS alone in the evaluation of benign and malignant breast lesions were: sensitivity(99.05% vs. 95.45%), specificity(89.52% vs. 88.02%), accuracy(92.96% vs. 90.70%). Positive predictive value(99.41% vs. 97.17%), negative predictive value(84.22% vs. 81.82%), false negative rate(0.95% vs. 4.55%) and false positive rate(10.48% vs. 11.98%), area under ROC curve(0.95 vs. 0.91, P<0.001), which is statistically different(P<0.001). Conclusion: Compared with HHUS alone, AUBS combined with HHUS has the ability to accurately estimate the risk of malignancy in BI-RADS 3~5 lesions, especially BI-RADS 4 lesions, which helps to improve the diagnostic efficiency of BI-RADS classification, reduce misdiagnosis, reduce diagnostic errors, and facilitate the early detection of atypical abnormal lesions, and provide more meaningful imaging evidence for distinguishing breast benign and malignant nodules, clinical puncture options, and postoperative evaluation.
ZHAO Ni,GAO Xi-can,SHU Rui, et al. Application of ABUS combined with HHUS in malignant risk assessment of BI-RADS type 3~5 breast lesions[J]. JOURNAL OF CHINA MEDICAL IMAGING, 2019, 30(7): 457-462.
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