Breast Multiparametric Ultrasound: A Single-Center Experience

This study aimed to evaluate the effectiveness of multiparametric ultrasound (mpUS) in characterizing focal breast lesions (FBLs). A total of 139 patients undergoing mpUS were included in this prospective study. Various ultrasound features were assessed, including US BI-RADS categories, vascularization patterns, and the presence of penetrating vessels using different Doppler methods (Color-Doppler, Power-Doppler, and Microvascular imaging). Strain elastography (SE) was used to evaluate the strain ratio (SR) and Tsukuba score (TS), while 2D-shear wave elastography (2D-SWE) measured parameters such as Emax, Emean, Emin, and Eratio. Core biopsies were performed for BI-RADS 4-5 lesions, while BI-RADS 2-3 lesions were monitored over a 24-month follow-up period. Diagnostic performance was assessed using the area under the curve (AUC), and cutoff values were determined using Youden’s index. Of the 139 FBLs, 53.9% were benign, while 46.1% were malignant. Significant differences were found between benign and malignant FBLs in terms of internal vascularization patterns, the presence of penetrating vessels, TS scores, and all 2D-SWE parameters. The BI-RADS score showed strong diagnostic performance with an AUC of 0.876 for detecting malignant FBLs. Among the 2D-SWE parameters, Emax and Emean demonstrated excellent diagnostic performance with AUCs of 0.915 and 0.908, respectively. Optimal cutoff values for diagnosing malignancy were US BI-RADS > 3, Strain Ratio > 2.52, Tsukuba Score > 3, Emax > 82.6 kPa, Emean > 66.0 kPa, Emin > 54.4 kPa, and Eratio > 330.8. Overall, the study concluded that mpUS, particularly 2D-SWE, significantly enhances the specificity of FBL characterization.