The British journal of radiology · 2026
The additional role of contrast-enhanced ultrasound in identifying lesions in pathological nipple discharge patients: a prospective study comparing with DCE-MRI.
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Niu Qinghua, Yang Shiyun, Du Lianfang, Jia Chao, Li Gang, Cai Yingyu, Chen An, Li Fan
Аннотация
OBJECTIVE: To evaluate the auxiliary role of contrast-enhanced ultrasound (CEUS) in the etiological diagnosis of pathological nipple discharge (PND) and compare its effectiveness with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI).
METHODS: In this prospective study conducted from March 2021 to February 2024, PND patients underwent breast ultrasound and DCE-MRI after initial history and physical examination. Lesions were categorized as mass or non-mass-like on baseline US and assessed for vascularity using colour Doppler. CEUS was utilized to refine the breast imaging reporting and data system (BI-RADS) classification. Logistic regression identified risk factors, and diagnostic performance was evaluated using receiver operating characteristic curve analysis.
RESULTS: A total of 116 lesions from 112 PND patients were analysed. CEUS-assisted ultrasound showed increased specificity (ranging from 50.0%-80.0% compared to US alone, P = .009) while maintaining sensitivity. Of the 81 patients who underwent DCE-MRI, CEUS demonstrated a higher positive predictive value (83.3% vs 75.5%), with comparable negative predictive values (97.0% vs 96.4%). CEUS was particularly effective in accurately diagnosing benign lesions that were overestimated by DCE-MRI and in identifying ductal carcinoma in situ with greater precision than US alone.
CONCLUSION: The auxiliary use of CEUS with ultrasound improves the specificity and positive predictive value in diagnosing PND-associated malignancies and serves as a valuable secondary imaging method to DCE-MRI, potentially reducing unnecessary biopsies of benign lesions.
ADVANCES IN KNOWLEDGE: CEUS can enhance the diagnostic accuracy of PND, effectively differentiating benign from malignant lesions, and its integration into clinical practice could offer significant benefits in patient management.
METHODS: In this prospective study conducted from March 2021 to February 2024, PND patients underwent breast ultrasound and DCE-MRI after initial history and physical examination. Lesions were categorized as mass or non-mass-like on baseline US and assessed for vascularity using colour Doppler. CEUS was utilized to refine the breast imaging reporting and data system (BI-RADS) classification. Logistic regression identified risk factors, and diagnostic performance was evaluated using receiver operating characteristic curve analysis.
RESULTS: A total of 116 lesions from 112 PND patients were analysed. CEUS-assisted ultrasound showed increased specificity (ranging from 50.0%-80.0% compared to US alone, P = .009) while maintaining sensitivity. Of the 81 patients who underwent DCE-MRI, CEUS demonstrated a higher positive predictive value (83.3% vs 75.5%), with comparable negative predictive values (97.0% vs 96.4%). CEUS was particularly effective in accurately diagnosing benign lesions that were overestimated by DCE-MRI and in identifying ductal carcinoma in situ with greater precision than US alone.
CONCLUSION: The auxiliary use of CEUS with ultrasound improves the specificity and positive predictive value in diagnosing PND-associated malignancies and serves as a valuable secondary imaging method to DCE-MRI, potentially reducing unnecessary biopsies of benign lesions.
ADVANCES IN KNOWLEDGE: CEUS can enhance the diagnostic accuracy of PND, effectively differentiating benign from malignant lesions, and its integration into clinical practice could offer significant benefits in patient management.