Using the Area Ratio to Differentiate Between Benign and Malignant Breast Lesions: Ultrasound Strain Elastography versus Contrast Enhanced Ultrasound

Purpose: To investigate the ability of ultrasound strain elastography (USE) and contrast enhanced ultrasound (CEUS) area ratio (AR) to differentiate between malignant and benign breast lesions. Methods: Sixty-six female patients with a breast lesion were enrolled in this prospective study between October 2015 and March 2018. All subjects underwent breast imaging with CEUS and USE to obtain dual display CEUS and USE images. Lesion area was measured using Adobe Photoshop CS5 software and the AR was calculated. The abilities of USE and CEUS AR to differentiate between malignant and benign breast lesions were analyzed using receiver-operating characteristic curve (ROC). Results: All 66 breast lesions (32 benign and 34 malignant lesions) were pathologically confirmed after surgery. The AR obtained with both USE (p < 0.001) and CEUS (p < 0.001) was significantly higher in malignant lesions than in benign ones. After ROC analysis, optimal cut-off value, sensitivity, specificity, and AUC for USE were 1.123, 61.8%, 87.5%, and 0.761, respectively; and for CEUS were 1.576, 67.6%, 90.6% and 0.844, respectively. These values were not statistically different between imaging modalities (z = 1.264, p = 0.206). Conclusions: The use of AR in USE and CEUS is a promising method to differentiate benign and malignant breast lesions.