title: Adjunctive targeted contrast-enhanced ultrasonography for the work-up of Breast Imaging Reporting and Data System category 3 and 4 lesions.
abstract: BACKGROUND
  The assessment and management of Breast Imaging Reporting and Data System category 3 and 4 lesions (BI-RADS 3 and 4 lesions respectively) present numerous challenges for breast radiologists and physicians due to the ambiguity in the classification guidelines. Different imaging modalities have been investigated for their ability to provide additional aid in classification and management. The aim of this study was to evaluate the utility of targeted contrast-enhanced ultrasonography (CEUS) as an adjunctive modality to mammography plus conventional ultrasound (MG + US) in the decision of whether further diagnostic work-up is needed for BI-RADS 3 and 4 lesions.
  
  
  METHODS
  A total of 37 MG + US-detected BI-RADS 3 lesions and 60 MG + US-detected BI-RADS 4 lesions were analysed by targeted CEUS and biopsied. The effectiveness of CEUS in distinguishing benign from malignant entities among the breast lesions was evaluated by using the histological results of biopsied samples as the gold standard.
  
  
  RESULTS
  Two BI-RADS 3 and 14 BI-RADS 4 lesions were diagnosed as true-positive findings by targeted CEUS, with negative predictive values (NPVs) of 100% and 89.2% respectively.
  
  
  CONCLUSIONS
  Owing to the high NPV of targeted CEUS, a negative diagnosis of MG + US-detected BI-RADS 3 lesions by targeted CEUS can be helpful in avoiding unnecessary biopsies. However, targeted CEUS cannot be used to exclude patients with BI-RADS 4 lesions from further diagnostic work-up.
authors.affiliation: Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiao-Ling
authors.initials: XL
authors.lastname: Zhang
authors.affiliation: Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Guan
authors.affiliation: Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Mei-Zhi
authors.initials: MZ
authors.lastname: Li
authors.affiliation: Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Ming-Juan
authors.initials: MJ
authors.lastname: Liu
authors.affiliation: Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Ultrasound, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: Zheng
authors.affiliation: Department of Pathology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Jian-Yong
authors.initials: JY
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D011873:Radiology Information Systems; D016217:Ultrasonography, Mammary / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: breast neoplasm; contrast-enhanced ultrasonography; diagnosis; mammography