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Quantitative Multiparametric Breast Ultrasound

Application of Contrast-Enhanced Ultrasound and Elastography Leads to an Improved Differentiation of Benign and Malignant Lesions

Kapetas, Panagiotis, MD*; Clauser, Paola, MD*; Woitek, Ramona, MD, PhD*,†; Wengert, Georg J., MD*; Lazar, Mathias, MD*; Pinker, Katja, MD, PhD, EBBI*,‡; Helbich, Thomas H., MD, MSc, MBA*; Baltzer, Pascal A.T., MD*

doi: 10.1097/RLI.0000000000000543
Original Articles

Objectives The aim of this study was to evaluate breast multiparametric ultrasound (mpUS) and its potential to reduce unnecessary breast biopsies with 1, 2, or 3 additional quantitative parameters (Doppler, elastography, and contrast-enhanced ultrasound [CEUS]) to B-mode and investigate possible variations with different reader experience.

Materials and Methods This prospective study included 124 women (age range, 18–82 years; mean, 52 years), each with 1 new breast lesion, scheduled for ultrasound-guided biopsy between October 2015 and September 2016. Each lesion was examined with B-mode, elastography (Virtual Touch IQ [VTIQ]), Doppler, and CEUS, and different quantitative parameters were recorded for each modality. Four readers (2 experienced breast radiologists and 2 in-training) independently evaluated B-mode images of each lesion and assigned a BI-RADS (Breast Imaging Reporting and Data System) score. Using the area under the receiver operating characteristic curve (AUC), the most accurate quantitative parameter for each modality was chosen. These were then combined with the BI-RADS scores of all readers. Descriptive statistics and AUC were used to evaluate the diagnostic performance of mpUS.

Results Sixty-five lesions were malignant. MpUS with B-mode and 2 additional quantitative parameters (VTIQ and CEUS or Doppler) showed the highest diagnostic performance for all readers (averaged AUCs, 0.812–0.789 respectively vs 0.683 for B-mode, P = 0.0001). Both combinations significantly reduced the number of false-positive findings up to 46.9% (P < 0.0001).

Conclusions Quantitative mpUS with 2 different triple assessment modalities (B-mode, VTIQ elastography, CEUS, or Doppler) shows the best diagnostic performance for breast cancer diagnosis and leads to a significant reduction of false-positive biopsy recommendations, for both experienced and inexperienced readers.

From the *Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria;

Department of Radiology, University of Cambridge, Cambridge, United Kingdom; and

Memorial Sloan-Kettering Cancer Center, Department of Radiology, Molecular Imaging and Therapy Service, New York, NY.

Received for publication September 29, 2018; and accepted for publication, after revision, November 16, 2018.

Conflicts of interest and sources of funding: none declared.

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Correspondence to: Thomas H. Helbich, MD, MSc, MBA, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria. E-mail:

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