title: Predictive model for contrast-enhanced ultrasound of the breast: Is it feasible in malignant risk assessment of breast imaging reporting and data system 4 lesions?
abstract: OBJECTIVE
  To build and evaluate predictive models for contrast-enhanced ultrasound (CEUS) of the breast to distinguish between benign and malignant lesions.
  
  
  METHODS
  A total of 235 breast imaging reporting and data system (BI-RADS) 4 solid breast lesions were imaged via CEUS before core needle biopsy or surgical resection. CEUS results were analyzed on 10 enhancing patterns to evaluate diagnostic performance of three benign and three malignant CEUS models, with pathological results used as the gold standard. A logistic regression model was developed basing on the CEUS results, and then evaluated with receiver operating curve (ROC).
  
  
  RESULTS
  Except in cases of enhanced homogeneity, the rest of the 9 enhancement appearances were statistically significant (P < 0.05). These 9 enhancement patterns were selected in the final step of the logistic regression analysis, with diagnostic sensitivity and specificity of 84.4% and 82.7%, respectively, and the area under the ROC curve of 0.911. Diagnostic sensitivity, specificity, and accuracy of the malignant vs benign CEUS models were 84.38%, 87.77%, 86.38% and 86.46%, 81.29% and 83.40%, respectively.
  
  
  CONCLUSIONS
  The breast CEUS models can predict risk of malignant breast lesions more accurately, decrease false-positive biopsy, and provide accurate BI-RADS classification.
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Luo
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Ji-Dong
authors.initials: JD
authors.lastname: Chen
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Lin-Xian
authors.initials: LX
authors.lastname: Yue
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Guo
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Lan
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Chi-Hua
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Jun Luo, Ji-Dong Chen, Qing Chen, Lin-Xian Yue, Guo Zhou, Cheng Lan, Department of Ultrasound, Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China.
authors.forename: Jing-Qiao
authors.initials: JQ
authors.lastname: Lu
keywords: Breast; Breast imaging reporting and data system; Contrast-enhanced ultrasound; Predictive model; Qualitative analysis