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Abstract：
BACKGROUND: Automated Breast Ultrasound (AB US) has shown good application value and prospects in breast disease screening and diagnosis. The aim of the study was to explore the ability of AB US to detect and diagnose mammographically Breast Imaging Reporting and Data System (BI-RADS) category 4 microcalcifications.
METHODS: 575 pathologically confirmed mammographically BI-RADS category 4 microcalcifications from January 2017 to June 2021 were included. All patients also completed AB US examinations. Based on the final pathological results, analyzed and summarized the AB US image features, and compared the evaluation results with mammography, to explore the detection and diagnostic ability of AB US for these suspicious microcalcifications.
RESULTS: 250 were finally confirmed as malignant and 325 were benign. Mammographic findings including microcalcifications morphology (61/80 with amorphous, coarse heterogeneous and fine pleomorphic, 13/14 with fine-linear or branching), calcification distribution (189/346 with grouped, 40/67 with linear and segmental), associated features (70/96 with asymmetric shadow), higher BI-RADS category with 4B (88/120) and 4 C (73/38) showed higher incidence in malignant lesions, and were the independent factors associated with malignant microcalcifications. 477 (477/575, 83.0%) microcalcifications were detected by AB US, including 223 malignant and 254 benign, with a significantly higher detection rate for malignant lesions (x2 = 12.20, P < 0.001). Logistic regression analysis showed microcalcifications with architectural distortion (odds ratio [OR] = 0.30, P = 0.014), with amorphous, coarse heterogeneous and fine pleomorphic morphology (OR = 3.15, P = 0.037), grouped (OR = 1.90, P = 0.017), liner and segmental distribution (OR = 8.93, P = 0.004) were the independent factors which could affect the detectability of AB US for microcalcifications. In AB US, malignant calcification was more frequent in a mass (104/154) or intraductal (20/32), and with ductal changes (30/41) or architectural distortion (58/68), especially with the both (12/12). BI-RADS category results also showed that AB US had higher sensitivity to malignant calcification than mammography (64.8% vs. 46.8%).
CONCLUSIONS: AB US has good detectability for mammographically BI-RADS category 4 microcalcifications, especially for malignant lesions. Malignant calcification is more common in a mass and intraductal in AB US, and tend to associated with architectural distortion or duct changes. Also, AB US has higher sensitivity than mammography to malignant microcalcification, which is expected to become an effective supplementary examination method for breast microcalcifications, especially in dense breasts.
METHODS: 575 pathologically confirmed mammographically BI-RADS category 4 microcalcifications from January 2017 to June 2021 were included. All patients also completed AB US examinations. Based on the final pathological results, analyzed and summarized the AB US image features, and compared the evaluation results with mammography, to explore the detection and diagnostic ability of AB US for these suspicious microcalcifications.
RESULTS: 250 were finally confirmed as malignant and 325 were benign. Mammographic findings including microcalcifications morphology (61/80 with amorphous, coarse heterogeneous and fine pleomorphic, 13/14 with fine-linear or branching), calcification distribution (189/346 with grouped, 40/67 with linear and segmental), associated features (70/96 with asymmetric shadow), higher BI-RADS category with 4B (88/120) and 4 C (73/38) showed higher incidence in malignant lesions, and were the independent factors associated with malignant microcalcifications. 477 (477/575, 83.0%) microcalcifications were detected by AB US, including 223 malignant and 254 benign, with a significantly higher detection rate for malignant lesions (x2 = 12.20, P < 0.001). Logistic regression analysis showed microcalcifications with architectural distortion (odds ratio [OR] = 0.30, P = 0.014), with amorphous, coarse heterogeneous and fine pleomorphic morphology (OR = 3.15, P = 0.037), grouped (OR = 1.90, P = 0.017), liner and segmental distribution (OR = 8.93, P = 0.004) were the independent factors which could affect the detectability of AB US for microcalcifications. In AB US, malignant calcification was more frequent in a mass (104/154) or intraductal (20/32), and with ductal changes (30/41) or architectural distortion (58/68), especially with the both (12/12). BI-RADS category results also showed that AB US had higher sensitivity to malignant calcification than mammography (64.8% vs. 46.8%).
CONCLUSIONS: AB US has good detectability for mammographically BI-RADS category 4 microcalcifications, especially for malignant lesions. Malignant calcification is more common in a mass and intraductal in AB US, and tend to associated with architectural distortion or duct changes. Also, AB US has higher sensitivity than mammography to malignant microcalcification, which is expected to become an effective supplementary examination method for breast microcalcifications, especially in dense breasts.
摘要：
背景：自动乳腺超声（ABUS）在乳腺疾病筛查和诊断中显示出良好的应用价值和前景。该研究的目的是探索ABUS检测和诊断乳腺X线摄影乳腺影像报告和数据系统（BI-RADS）4类微钙化的能力。
方法：纳入了2017年1月至2021年6月经病理证实的575例乳腺BI-RADS4类微钙化。所有患者还完成了ABUS检查。根据最终的病理结果，分析和总结了ABUS图像特征，并将评估结果与乳房X光检查进行了比较，探讨ABUS对这些可疑微钙化的检测和诊断能力。
结果：最终确认为恶性的250例，良性的325例。包括微钙化形态的钼靶检查结果（61/80，无定型，粗糙异质和精细多态，13/14，具有细线性或分支），钙化分布（189/346分组，40/67，具有线性和分段），相关特征（具有不对称阴影的70/96），较高的BI-RADS类别与4B（88/120）和4C（73/38）在恶性病变中显示较高的发病率，并且是与恶性微钙化相关的独立因素。ABUS检测到477（477/575，83.0%）微钙化，包括223个恶性和254个良性，恶性病变检出率明显较高(x2=12.20,P<0.001)。Logistic回归分析显示微钙化伴结构畸变(比值比[OR]=0.30,P=0.014),无定形的，粗糙异质和精细多形性形态(OR=3.15，P=0.037)，分组(OR=1.90，P=0.017)，线性和节段分布（OR=8.93，P=0.004）是影响ABUS微钙化可检测性的独立因素。在AB美国，恶性钙化在肿块（104/154）或导管内（20/32）中更常见，导管变化（30/41）或建筑扭曲（58/68），尤其是两者（12/12）。BI-RADS分类结果还显示，ABUS对恶性钙化的敏感性高于乳房X线照相术（64.8％vs.46.8%）。
结论：ABUS对乳腺造影BI-RADS4类微钙化具有良好的可检测性，尤其是恶性病变。恶性钙化在ABUS的肿块和导管内更常见，并倾向于与建筑扭曲或管道变化有关。此外，ABUS对恶性微钙化的敏感性高于乳房X线照相术，有望成为乳腺微钙化的有效补充检查方法，尤其是在密集的乳房中。
方法：纳入了2017年1月至2021年6月经病理证实的575例乳腺BI-RADS4类微钙化。所有患者还完成了ABUS检查。根据最终的病理结果，分析和总结了ABUS图像特征，并将评估结果与乳房X光检查进行了比较，探讨ABUS对这些可疑微钙化的检测和诊断能力。
结果：最终确认为恶性的250例，良性的325例。包括微钙化形态的钼靶检查结果（61/80，无定型，粗糙异质和精细多态，13/14，具有细线性或分支），钙化分布（189/346分组，40/67，具有线性和分段），相关特征（具有不对称阴影的70/96），较高的BI-RADS类别与4B（88/120）和4C（73/38）在恶性病变中显示较高的发病率，并且是与恶性微钙化相关的独立因素。ABUS检测到477（477/575，83.0%）微钙化，包括223个恶性和254个良性，恶性病变检出率明显较高(x2=12.20,P<0.001)。Logistic回归分析显示微钙化伴结构畸变(比值比[OR]=0.30,P=0.014),无定形的，粗糙异质和精细多形性形态(OR=3.15，P=0.037)，分组(OR=1.90，P=0.017)，线性和节段分布（OR=8.93，P=0.004）是影响ABUS微钙化可检测性的独立因素。在AB美国，恶性钙化在肿块（104/154）或导管内（20/32）中更常见，导管变化（30/41）或建筑扭曲（58/68），尤其是两者（12/12）。BI-RADS分类结果还显示，ABUS对恶性钙化的敏感性高于乳房X线照相术（64.8％vs.46.8%）。
结论：ABUS对乳腺造影BI-RADS4类微钙化具有良好的可检测性，尤其是恶性病变。恶性钙化在ABUS的肿块和导管内更常见，并倾向于与建筑扭曲或管道变化有关。此外，ABUS对恶性微钙化的敏感性高于乳房X线照相术，有望成为乳腺微钙化的有效补充检查方法，尤其是在密集的乳房中。
