A Diagnostic Model for Breast Lesions With Enlarged Enhancement Extent on Contrast-Enhanced Ultrasound Improves Malignancy Prediction

Objective: The aim of the work described here was to develop a diagnostic model based on contrast-enhanced ultrasound (CEUS) features to improve performance in predicting the probability of malignancy for breast lesions with an enlarged enhancement extent on CEUS.Methods: In total, 299 consecutive patients who underwent CEUS examination and had confirmed pathological results were retrospectively enrolled. Among the 299 patients, an enlarged enhancement extent on CEUS was found in 142 patients. In this special cohort, we analyzed the association of malignant pathologic results with per-fusion patterns emphatically by reclassifying the patterns.Results: A diagnostic model was developed and presented as a nomogram, assessed with discrimination and cali-bration. Receiver operating characteristic (ROC) curve analysis revealed that the areas under the curves of the conventional perfusion and modified perfusion patterns were 0.58 and 0.76 (p < 0.001), respectively. A diagnos-tic model was built and exhibited good discrimination with a C-index of 0.95 (95% confidence interval: 0.91 -0.98), which was confirmed to be 0.93 via internal bootstrapping validation. Conclusion: The nomogram based on CEUS features provides radiologists with a quantitative tool to predict the probability of malignancy in this special cohort of breast lesions.