Head-to-head comparison of perfluorobutane contrast-enhanced US and multiparametric MRI for breast cancer: a prospective, multicenter study

Manlin Lang; Ping Liang; Huiming Shen; Hang Li; Ning Yang; Bo Chen; Yixu Chen; Hong Ding; Weiping Yang; Xiaohui Ji; Ping Zhou; Ligang Cui; Jiandong Wang; Wentong Xu; Xiuqin Ye; Zhixing Liu; Yu Yang; Tianci Wei; Hui Wang; Yuanyuan Yan; Changjun Wu; Yiyun Wu; Jingwen Shi; Yaxi Wang; Xiuxia Fang; Ran Li; Jie Yu

doi:10.1186/s13058-023-01650-3

Head-to-head comparison of perfluorobutane contrast-enhanced US and multiparametric MRI for breast cancer: a prospective, multicenter study

Breast Cancer Res. 2023 May 30;25(1):61. doi: 10.1186/s13058-023-01650-3.

Authors

Manlin Lang^#¹, Ping Liang^#², Huiming Shen³, Hang Li⁴, Ning Yang⁵, Bo Chen⁶, Yixu Chen⁷, Hong Ding⁸, Weiping Yang⁹, Xiaohui Ji¹⁰, Ping Zhou¹¹, Ligang Cui¹², Jiandong Wang¹³, Wentong Xu¹³, Xiuqin Ye¹⁴, Zhixing Liu¹⁵, Yu Yang¹⁶, Tianci Wei¹⁷, Hui Wang¹⁸, Yuanyuan Yan¹⁹, Changjun Wu²⁰, Yiyun Wu²¹, Jingwen Shi²², Yaxi Wang²³, Xiuxia Fang²³, Ran Li²⁴, Jie Yu²⁵

Affiliations

¹ Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital & Chinese PLA Medical School, Beijing, 100039, China.
² Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China.
³ Department of Ultrasound, Zhongda Hospital Southeast University, Nanjing, 210009, China.
⁴ Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, 351100, China.
⁵ Department of Ultrasound, Xingcheng People's Hospital, Xingcheng, 125100, China.
⁶ Department of Ultrasound Medicine, Lu'an People's Hospital of Anhui Province, Liuan, 237000, China.
⁷ Department of Ultrasound, The Fifth People's Hospital of Chengdu, Chengdu, 611130, China.
⁸ Department of Ultrasound, Huashan Hospital, Shanghai, 200040, China.
⁹ Department of Ultrasound, Guangxi Medical University Cancer Hospital, Nanning, 530021, China.
¹⁰ Department of Ultrasound, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
¹¹ Department of Ultrasound, The Third Xiangya Hospital, Changsha, 410000, China.
¹² Department of Ultrasound, Peking University Third Hospital, Beijing, 100191, China.
¹³ General Surgery, Chinese PLA General Hospital, Beijing, 100853, China.
¹⁴ Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen Medical Ultrasound Engineering Center, Shenzhen People's Hospital, Shenzhen, 518020, China.
¹⁵ Department of Ultrasound Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
¹⁶ Department of Ultrasound, Beijing Friendship Hospital, Beijing, 100050, China.
¹⁷ Department of Ultrasound, The 2nd Affiliated Hospital of Harbin, Harbin, 150001, China.
¹⁸ Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, 130033, China.
¹⁹ Department of Ultrasound, Zhengzhou Central Hospital, Zhengzhou, 450000, China.
²⁰ Department of Ultrasonography, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
²¹ Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
²² Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
²³ Department of Ultrasound, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, China.
²⁴ Department of Ultrasound, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, 453100, China.
²⁵ Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China. jiemi301@163.com.

^# Contributed equally.

Abstract

Background: Multiparametric magnetic resonance imaging (MP-MRI) has high sensitivity for diagnosing breast cancers but cannot always be used as a routine diagnostic tool. The present study aimed to evaluate whether the diagnostic performance of perfluorobutane (PFB) contrast-enhanced ultrasound (CEUS) is similar to that of MP-MRI in breast cancer and whether combining the two methods would enhance diagnostic efficiency.

Patients and methods: This was a head-to-head, prospective, multicenter study. Patients with breast lesions diagnosed by US as Breast Imaging Reporting and Data System (BI-RADS) categories 3, 4, and 5 underwent both PFB-CEUS and MP-MRI scans. On-site operators and three reviewers categorized the BI-RADS of all lesions on two images. Logistic-bootstrap 1000-sample analysis and cross-validation were used to construct PFB-CEUS, MP-MRI, and hybrid (PFB-CEUS + MP-MRI) models to distinguish breast lesions.

Results: In total, 179 women with 186 breast lesions were evaluated from 17 centers in China. The area under the receiver operating characteristic curve (AUC) for the PFB-CEUS model to diagnose breast cancer (0.89; 95% confidence interval [CI] 0.74, 0.97) was similar to that of the MP-MRI model (0.89; 95% CI 0.73, 0.97) (P = 0.85). The AUC of the hybrid model (0.92, 95% CI 0.77, 0.98) did not show a statistical advantage over the PFB-CEUS and MP-MRI models (P = 0.29 and 0.40, respectively). However, 90.3% false-positive and 66.7% false-negative results of PFB-CEUS radiologists and 90.5% false-positive and 42.8% false-negative results of MP-MRI radiologists could be corrected by the hybrid model. Three dynamic nomograms of PFB-CEUS, MP-MRI and hybrid models to diagnose breast cancer are freely available online.

Conclusions: PFB-CEUS can be used in the differential diagnosis of breast cancer with comparable performance to MP-MRI and with less time consumption. Using PFB-CEUS and MP-MRI as joint diagnostics could further strengthen the diagnostic ability. Trial registration Clinicaltrials.gov; NCT04657328. Registered 26 September 2020. IRB number 2020-300 was approved in Chinese PLA General Hospital. Every patient signed a written informed consent form in each center.

Keywords: Breast lesions; Diagnostic model; Diagnostic performance; Hybrid; MP-MRI; PFB-CEUS.

Publication types

Multicenter Study

MeSH terms

Breast Neoplasms* / diagnostic imaging
Breast Neoplasms* / pathology
Contrast Media
Female
Humans
Magnetic Resonance Imaging / methods
Multiparametric Magnetic Resonance Imaging*
Prospective Studies
Sensitivity and Specificity
Ultrasonography, Mammary / methods

Substances

Contrast Media
perfluorobutane

Associated data

ClinicalTrials.gov/NCT04657328