BREAST RADIOLOGY / ORIGINAL PAPER
An observational study of contrast-enhanced ultrasound in diagnosing malignant breast masses
1
Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
These authors had equal contribution to this work
Submission date: 2025-08-14
Final revision date: 2026-01-26
Acceptance date: 2026-02-14
Publication date: 2026-04-08
Corresponding author
Apurva Surana
Senior Resident, Department of Diagnostic and Interventional Radiology, AIIMS Jodhpur, Basni – 2nd Phase, Jodhpur-342005, India
Senior Resident, Department of Diagnostic and Interventional Radiology, AIIMS Jodhpur, Basni – 2nd Phase, Jodhpur-342005, India
Pol J Radiol, 2026; 91(1): 169-178
KEYWORDS
TOPICS
ABSTRACT
Purpose:
To study the diagnostic role of contrast-enhanced ultrasound (CEUS) in terms of sensitivity, specificity, and its comparison with grey-scale ultrasound with colour Doppler in characterising malignant breast masses.
Material and methods:
An observational study was done for duration of 18 months, including 64 adult females with breast masses. Patients underwent various investigations in the form of conventional ultrasound with colour Doppler and CEUS. Patients underwent surgery, and a histopathological examination was performed on a surgical specimen for confirmation of a benign or malignant lesion. Outcome measures were the proportion of benign and malignant lesions of the breast and the diagnostic accuracy of CEUS in characterising malignant lesions in the breast.
Results:
On analysis, CEUS showed very good agreement with histopathological diagnosis with κ 0.967 (p < 0.0001); while good agreement was found between histopathological diagnosis and diagnosis by B mode + colour Doppler with κ 0.772 (p < 0.0001). CEUS demonstrated sensitivity of 100%, specificity of 96.15%, and AUC of 0.98, while diagnosis B mode + colour Doppler yielded sensitivity of 92.11%, specificity of 84.62%, and diagnostic accuracy of 89.06%.
Conclusions:
CEUS was found to have a better diagnostic accuracy for differentiation of benign and malignant breast masses (using histopathology as a gold standard). The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CEUS was found to be 99%, 96%, 97.4%, 99%, and 98.4% respectively.
To study the diagnostic role of contrast-enhanced ultrasound (CEUS) in terms of sensitivity, specificity, and its comparison with grey-scale ultrasound with colour Doppler in characterising malignant breast masses.
Material and methods:
An observational study was done for duration of 18 months, including 64 adult females with breast masses. Patients underwent various investigations in the form of conventional ultrasound with colour Doppler and CEUS. Patients underwent surgery, and a histopathological examination was performed on a surgical specimen for confirmation of a benign or malignant lesion. Outcome measures were the proportion of benign and malignant lesions of the breast and the diagnostic accuracy of CEUS in characterising malignant lesions in the breast.
Results:
On analysis, CEUS showed very good agreement with histopathological diagnosis with κ 0.967 (p < 0.0001); while good agreement was found between histopathological diagnosis and diagnosis by B mode + colour Doppler with κ 0.772 (p < 0.0001). CEUS demonstrated sensitivity of 100%, specificity of 96.15%, and AUC of 0.98, while diagnosis B mode + colour Doppler yielded sensitivity of 92.11%, specificity of 84.62%, and diagnostic accuracy of 89.06%.
Conclusions:
CEUS was found to have a better diagnostic accuracy for differentiation of benign and malignant breast masses (using histopathology as a gold standard). The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of CEUS was found to be 99%, 96%, 97.4%, 99%, and 98.4% respectively.
REFERENCES (20)
1.
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74: 229-263.
2.
Singh K, Grover A, Dhanasekaran K. Unveiling the cancer epidemic in India: a glimpse into GLOBOCAN 2022 and past patterns. Lancet 2025; 34: 100546. DOI: 10.1016/j.lansea.2025.100546.
3.
Cao W, Chen HD, Yu YW, Li N, Chen WQ. Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020. Chin Med J (Engl) 2021; 134: 783-791.
4.
Jia WR, Chai WM, Tang L, Wang Y, Fei XC, Han BS, et al. Three-dimensional contrast enhanced ultrasound score and dynamic contrast-enhanced magnetic resonance imaging score in evaluating breast tumor angiogenesis: correlation with biological factors. Eur J Radiol 2014; 83: 1098-1105.
5.
He H, Wu X, Jiang M, Xu Z, Zhang X, Pan J, et al. Diagnostic accuracy of contrast-enhanced ultrasound synchronized with shear wave elastography in the differential diagnosis of benign and malignant breast lesions: a diagnostic test. Gland Surg 2023; 12: 54-66.
6.
Luo J, Chen JD, Chen Q, Yue LX, Zhou G, Lan C, et al. Predictive model for contrast-enhanced ultrasound of the breast: Is it feasible in malignant risk assessment of breast imaging reporting and data system 4 lesions? World J Radiol 2016; 8: 600-609.
7.
Fang K, Wang L, Huang H, Lan M, Shen D, Dong S, et al. Construction of nucleolin-targeted lipid nanobubbles and contrast-enhanced ultrasound molecular imaging in triple-negative breast cancer. Pharm Res 2020; 37: 145. DOI: 10.1007/s11095-020-02873-1.
8.
Lee SC, Tchelepi H, Grant E, Desai B, Luo C, Groshen S, et al. Contrast-enhanced ultrasound imaging of breast masses: adjunct tool to decrease the number of false-positive biopsy results. J Ultrasound Med 2019; 38: 2259-2273.
9.
Li X, Li Y, Zhu Y, Fu L, Liu P. Association between enhancement patterns and parameters of contrast-enhanced ultrasound and microvessel distribution in breast cancer. Oncol Lett 2018; 15: 5643-5649.
10.
Grewal DS, Bhanu KU, Sahni H, Maheshwari S, Kakria N, Mishra PS, et al. Role of qualitative contrast-enhanced ultrasound in the diagnosis of malignant breast lesions. Med J Armed Forces India 2023; 79: 414-420.
11.
Wang J, Zhao R, Cheng J. Diagnostic accuracy of contrast-enhanced ultrasound to differentiate benign and malignant breast lesions: a systematic review and meta-analysis. Eur J Radiol 2022; 149: 110219. DOI: 10.1016/j.ejrad.2022.110219.
12.
Tang L, Chen Y, Du Z, Zhong Z, Chen Q, Yang L, et al. A multicenter study of a contrast-enhanced ultrasound diagnostic classification of breast lesions. Cancer Manag Res 2019; 11: 2163-2170.
13.
Wan C, Du J, Fang H, Li F, Wang L. Evaluation of breast lesions by contrast enhanced ultrasound: qualitative and quantitative analysis. Eur J Radiol 2012; 81: e444-e450. DOI: 10.1016/j.ejrad.2011.03.094.
14.
Wang Y, Fan W, Zhao S, Zhang K, Zhang L, Zhang P, Ma R. Qualitative, quantitative and combination score systems in differential diagnosis of breast lesions by contrast-enhanced ultrasound. Eur J Radiol 2016; 85: 48-54.
15.
Spak DA, Plaxco JS, Santiago L, Dryden MJ, Dogan BE. BI-RADS® fifth edition: a summary of changes. Diagn Interv Imaging 2017; 98: 179-190.
16.
Huang R, Jiang L, Xu Y, Gong Y, Ran H, Wang Z, et al. Comparative diagnostic accuracy of contrast-enhanced ultrasound and shear wave elastography in differentiating benign and malignant lesions: a network meta-analysis. Front Oncol 2019; 9: 102. DOI: 10.3389/fonc.2019.00102.
17.
Watanabe T, Yamaguchi T, Okuno T, Konno S, Takaki R, Sato M, et al. Utility of B-mode, color Doppler and elastography in the diagnosis of breast cancer: results of the CD-CONFIRM multicenter study of 1351 breast solid masses. Ultrasound Med Biol 2021; 47: 3111-3121.
18.
Hashim HA, Mahmoud MZ, Alonazi B, Aldosary H, Alrashdi JS, Alabdulrazaq FA, et al. Brightness mode and color Doppler ultrasound in differential diagnosis of breast lesions in Saudi Females. J Clin Imaging Sci 2019; 9: 36. DOI: 10.25259/JCIS_51_2019.
19.
Yuan Y, Xu M, Ren Y, He L, Chen J, Sun L. Clinical value of contrast-enhanced ultrasound in breast cancer diagnosis. Comput Math Methods Med 2022; 2022: 2017026. DOI: 10.1155/2022/2017026.
20.
Zhu Y, Zhang D, Wang XN, Chen YN, Pan MF, Guerrini S, et al. Diagnostic test of conventional ultrasonography combined with contrast-enhanced ultrasound in the subcategorization of suspicious Breast Imaging-Reporting and Data System (BI-RADS) 4 breast lesions. Transl Cancer Res 2025; 14: 2066-2077.
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