J Cancer 2020; 11(13):3903-3909. doi:10.7150/jca.43326 This issue

Research Paper

Can Combined Screening of Ultrasound and Elastography Improve Breast Cancer Identification Compared with MRI in Women with Dense Breasts-a Multicenter Prospective Study

Lu-Ying Gao1, Yang Gu1, Wen Xu1, Jia-Wei Tian2, Li-Xue Yin3, Hai-Tao Ran4, Wei-Dong Ren5, Yu-Ming Mu6, Jie-Ying Zhang7, Cai Chang8, Jian-Jun Yuan9, Chun-Song Kang10, You-Bin Deng11, Hui Wang12, Xiao-Yan Xie13, Bao-Ming Luo14, Sheng-Lan Guo15, Qi Zhou16, En-Sheng Xue17, Wei-Wei Zhan18, Tong Jiao19, Qing Zhou20, Jie Li21, Ping Zhou22, Pin-Tong Huang23, Hong-Yuan Xue24, Chun-Quan Zhang25, Man Chen26, Xiang-Xiang Jing27, Ying Gu28, Jian-Feng Guo29, Hong-Yu Ding30, Jin-Feng Xu31, Wu Chen32, Li Liu33, Yu-Hong Zhang34, Hong-Qiao Wang35, Zhong-Ping Mu36, Jian-Chu Li1, Hong-Yan Wang1,*,✉, Yu-Xin Jiang1,*,✉

1. Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
2. Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
3. Cardiovascular Ultrasound and Non-invasive Cardiology Department, Key Laboratory of Ultrasound in Cardiac Electrophysiology and Bio-mechanics of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People′s Hospital, Chengdu 610072, China
4. Department of Ultrasound, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, China
5. Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, China
6. Department of Ultrasonography, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
7. Department of Radiology, Cancer Institute &Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
8. Department of Medical Ultrasound, Fudan University Shanghai Cancer Center & Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
9. Department of Ultrasonography, Henan Provincial People′s Hospital, Zhengzhou 450003, China
10. Department of Ultrasound, Shanxi Academy of Medical Science, Dayi Hospital of Shanxi Medical University, Taiyuan 030032, China
11. Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
12. Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun 130033, China
13. Department of Medical Ultrasonics, Division of Interventional Ultrasound, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
14. Department of Ultrasound, the Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
15. Department of Ultrasonography, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
16. Department of Medical Ultrasound, the Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, China
17. Department of Ultrasound, Union Hospital of Fujian Medical University, Fujian Institute of Ultrasound Medicine, Fuzhou 350001, China
18. Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
19. Department of Ultrasound, Tianjin Union Medicine Hospital, Tianjin 300121, China
20. Department of Ultrasonography, Renmin Hospital of Wuhan University, Wuhan 430060, China
21. Department of Ultrasound, Qilu Hospital, Shandong University, Jinan 250012, China
22. Department of Ultrasound, the Third Xiangya Hospital of Central South University, Changsha 410013, China
23. Department of Ultrasound, the Second Affiliated Hospital of Zhejiang University, Hangzhou 310000, China
24. Department of Ultrasound, Hebei General Hospital, Shijiazhuang 050000, China
25. Department of Ultrasound, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
26. Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
27. Department of Ultrasound, Hainan Provincial People's Hospital, Haikou 570311, China
28. Department of Ultrasonography, the Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
29. Department of Ultrasound, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215001, China
30. Department of Ultrasonography, Qianfoshan Hospital of Shandong University, Jinan 250014, China
31. Department of Ultrasound, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University, Shenzhen 518020, China
32. Department of Ultrasound, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
33. Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen 518036, China
34. Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian 116027, China
35. Department of Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
36. Department of Ultrasound, Maternal and Child Health Care Hospital Affiliated to Medical University of Anhui, Anhui Province Maternal and Child Health Hospital, Hefei 230001, China
*These authors contributed equally to this work.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Gao LY, Gu Y, Xu W, Tian JW, Yin LX, Ran HT, Ren WD, Mu YM, Zhang JY, Chang C, Yuan JJ, Kang CS, Deng YB, Wang H, Xie XY, Luo BM, Guo SL, Zhou Q, Xue ES, Zhan WW, Jiao T, Zhou Q, Li J, Zhou P, Huang PT, Xue HY, Zhang CQ, Chen M, Jing XX, Gu Y, Guo JF, Ding HY, Xu JF, Chen W, Liu L, Zhang YH, Wang HQ, Mu ZP, Li JC, Wang HY, Jiang YX. Can Combined Screening of Ultrasound and Elastography Improve Breast Cancer Identification Compared with MRI in Women with Dense Breasts-a Multicenter Prospective Study. J Cancer 2020; 11(13):3903-3909. doi:10.7150/jca.43326. Available from https://www.jcancer.org/v11p3903.htm

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Objectives: To assess the performance of elastography (ES) and ultrasound (US) in predicting the malignancy of breast lesions and to compare their combined diagnostic value with that of magnetic resonance imaging (MRI).

Materials and Methods: The study prospectively enrolled 242 female patients with dense breasts treated in 35 heath care facilities in China between November 2018 and October 2019. Based on conventional US and elastography, radiologists classified the degree of suspicion of breast lesions according to the US Breast Imaging Reporting and Data System (BI-RADS) criteria. The diagnostic value was compared between US BI-RADS and MRI BI-RADS, with pathological results used as the reference standard.

Results: The results demonstrated that irregular tumor shape, a nonparallel growth orientation, indistinct margins, angular contours, microcalcifications, color Doppler flow and ES score on US imaging were significantly related to breast cancer in dense breasts (P=0.001; P=0.001; P=0.008; P<0.001; P=0.019; P=0.008; P=0.002, respectively). The sensitivity, specificity, PPV, NPV, accuracy and AUC of US BI-RADS category were 94.7%, 90.7%, 95.8%, 88.0%, 93.4% and 0.93 (95%CI, 0.88-0.97), respectively, while those of MRI BI-RADS category were 98.2%, 57.5%, 84.3%, 83.3%, 86.0% and 0.78 (95%CI, 0.71-0.85), respectively. MRI BI-RADS showed a significantly higher sensitivity than US BI-RADS (98.2% vs 94.7%, P=0.043), whereas US BI-RADS showed significantly higher specificity (90.7% vs 57.5%, P<0.001). US BI-RADS showed better diagnostic efficiency in differentiating nodules in dense breasts than MRI BI-RADS (AUC 0.93 vs 0.78, P<0.001).

Conclusion: By combining the use of ES and conventional US, US BI-RADS had better diagnostic efficiency in differentiating nodules in dense breasts than MRI. For the diagnosis of malignant tumors in patients with dense breasts, MRI and US BI-RADS can be used as supplemental diagnostic tools to detect lesions, with US BI-RADS considered the preferred adjunctive resource.

Keywords: Breast cancer, Dense breast, Breast Imaging Reporting and Data System (BI-RADS), Elastography, Magnetic resonance imaging (MRI), Ultrasound (US)