title: Contrast-enhanced ultrasound improved performance of breast imaging reporting and data system evaluation of critical breast lesions.
abstract: OBJECTIVE
  To determine whether contrast-enhanced ultrasound (CEUS) can improve the precision of breast imaging reporting and data system (BI-RADS) categorization.
  
  
  METHODS
  A total of 230 patients with 235 solid breast lesions classified as BI-RADS 4 on conventional ultrasound were evaluated. CEUS was performed within one week before core needle biopsy or surgical resection and a revised BI-RADS classification was assigned based on 10 CEUS imaging characteristics. Receiver operating characteristic curve analysis was then conducted to evaluate the diagnostic performance of CEUS-based BI-RADS assignment with pathological examination as reference criteria.
  
  
  RESULTS
  The CEUS-based BI-RADS evaluation classified 116/235 (49.36%) lesions into category 3, 20 (8.51%), 13 (5.53%) and 12 (5.11%) lesions into categories 4A, 4B and 4C, respectively, and 74 (31.49%) into category 5. Selecting CEUS-based BI-RADS category 4A as an appropriate cut-off gave sensitivity and specificity values of 85.4% and 87.8%, respectively, for the diagnosis of malignant disease. The cancer-to-biopsy yield was 73.11% with CEUS-based BI-RADS 4A selected as the biopsy threshold compared with 40.85% otherwise, while the biopsy rate was only 42.13% compared with 100% otherwise. Overall, only 4.68% of invasive cancers were misdiagnosed.
  
  
  CONCLUSIONS
  This pilot study suggests that evaluation of BI-RADS 4 breast lesions with CEUS results in reduced biopsy rates and increased cancer-to-biopsy yields.
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: Biopsy; Breast imaging reporting and data system; Contrast-enhanced ultrasound; False positive biopsy