Objective:

To explore the additional diagnostic value of contrast-enhanced ultrasound (C

EUS) and ultrasonic elastography (ES) for clinically non-palpable breast mass categorized as Breast Imaging Report and Data System (BI-RADS) 4 by conventional ultrasound.

Methods:

The clinical and imaging data of patients with breast mass admitted in the hospital from January 2019 to September 2022 were retrospectively analyzed. All the patients had pathological results after surgical excision

and the results of ultrasound

shear wave elastography (SWE) and CEUS imaging data as well. The quantitative and qualitative indexes were analyzed on SWE images

and the arterial phase indexes were analyzed on CEUS images under the post-processing mode of arrival-time parametric imaging (At-PI). Multivariate logistic regression was performed to obtain the independent predictive indexes

and the diagnostic performance of different modes was compared.

Results:

Finally

101 lesions from 101 patients were included in this study

of which 42 were malignant and 59 were benign

and there was no significant difference in size between the benign and malignant groups. There was a significant difference in all the signs of SWE except “rim sign” between the two groups (

P

＜0.05). The CEUS、 images were analyzed under the At-PI mode

and high consistency between senior and junior radiologist was obtained (0.822~0.921). The results of multivariate logistic regression analysis indicated that the effective indexes of SWE to predict malignant lesions werereasonably homogenous/heterogeneous in color and E

max

≥20.45 kPa. The corresponding indexes of CEUS were shape irregular after enhancement

contrast agent perfusion defect

and contrast agent retention in the venous phase. As for clinically non-palpable breast lesions categorized as BI-RADS 4

ultrasound combined with SWE or CEUS could improve diagnostic performance compared with ultrasound alone (

P

＜0.05)

and the performance of combination with CEUS was better than that with SWE (

P

=0.001 4). The improved performance was

more obvious for BI-RADS 4a lesions

but there was no significantly improved performance for BI-RADS 4b lesions.

Conclusion:

The combination with SWE or CEUS can improve diagnostic performance for clinically non-palpable breast mass categorized as BI-RADS 4

and the additional performance of combination with CEUS is better than that with SWE

especially for BI-RADS 4a lesions.