Objective:

To explore the independent predictive risk factors and their predictive value of conventional ultrasound and contrast-enha

nced ultrasound (CEUS) sonographic performance for high-grade ductal carcinoma

in situ

(DCIS) of the breast.

Methods:

Clinical and ultrasound imaging data of patients diagnosed with DCIS between January 2018 and December 2021 were retrospectively analyzed. Included patients underwent surgical resection to obtain final pathology with clear nuclear grading results. Included patients had preoperative well-established and good quality conventional ultrasound and CEUS imaging data within 1 month

and independent predictors on conventional ultrasound and CEUS were analyzed by multifactorial logistic regression and predictive efficacy was calculated.

Results:

Finally

94 simple DCIS lesions were included in the study

including 23 cases of low grade

41 cases of intermediate grade and 30 cases of high grade. Low and intermediate grade were grouped together and high grade were grouped together

and there were no significant differences in patient age

focus maximum diameter

symptoms and lymph node metastasis between the two groups. The morphological classification of lesions on conventional ultrasound (i.e.

mass-like and non-mass-like) and the presence of microcalcifications were significantly different between the groups (

P

＜0.05)

and microcalcifications were independent predictors of risk with an odd ratio (OR) value of 3.071 and an area under the curve (AUC) of 0.636 (

P

=0.014). On CEUS

there were significant differences between the groups of enhancement uniformity

presence of radial vessels at the edge of the lesion and signs of increased extent after enhancement (

P

＜0.05)

with radial vessels at the edge being an independent predictor (OR=3.319

AUC=0.640

P

=0.013). The combined modalities of conventional ultrasound and CEUS predicted high-level. The sensitivity

specificity and AUC of DCIS were 46.7%

90.6% and 0.686

respectively

and the specificity of the combination was significantly higher than that of conventional ultrasound or CE

US modality alone (

P

＜0.05).

Conclusion:

Both conventional ultrasound and CEUS sonographic manifestations can help to predict high-grade DCIS

with microcalcifications on conventional ultrasound and radial vessels at the lesion margin on CEUS as independent predictors

and the combination of both significantly can improve the predictive specificity compared with modality alone.