Value of sonographic bidirectional arterial flow combined with elastography for diagnosis of breast imaging reporting and data system category 4 breast masses.
OBJECTIVE
The purpose of this study was to evaluate the role of bidirectional arterial flow combined with ultrasound elastography for differentiation of American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category 4 masses.


METHODS
A total of 116 BI-RADS category 4 breast masses were evaluated with color Doppler sonography, spectral analysis, and elastography. The sensitivity, specificity, accuracy, positive and negative predictive values, and receiver operator characteristic curve were used to estimate the diagnostic performance for each modality and the combination method.


RESULTS
The combination method had the best sensitivity (81.1%) but less specificity (94.9%) and the best accuracy (90.5%). The discriminating power of the combined method (area under the curve [AUC], 0.880; 95% confidence interval [CI], 80.0%-96.0%) was significantly higher than that of bidirectional arterial flow (AUC, 0.818; 95% CI, 72.0%-91.6%; P< .01) and elastography (AUC, 0.765; 95% CI, 65.9%-87.0%; P< .01).


CONCLUSIONS
Bidirectional arterial flow evaluation, when combined with elastography, could potentially improve diagnostic accuracy for BI-RADS category 4 breast masses.
Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China.
Da
D
Liu
Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China huangying712@163.com.
Ying
Y
Huang
Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China.
Dan
D
Tian
Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China.
Jing
J
Yin
Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China.
Li-Jun
LJ
Deng
D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D001943:Breast Neoplasms / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002648:Child; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*; D055815:Young Adult
Breast Imaging Reporting and Data System; arterial flow; bidirectional flow; breast cancer; breast ultrasound; elastography