Can the new combined CEUS-BI-RADS score (CB score) reduce the number of breast false positive biopsies? Results from a monocentric study.

[PURPOSE] The aim of this study was to develop a new contrast-enhanced ultrasound (CEUS)-based scoring system to distinguish between benign and malignant lesions and to evaluate its potential in obviating unnecessary ultrasound-guided breast biopsies.

[METHODS] Between November 2019 and June 2023, women with newly diagnosed breast lesions (BI-RADS 4a-c and 5) scheduled for ultrasound-guided biopsy and who underwent CEUS were retrospectively included. Two independent readers (one highly experienced breast radiologist with > 10 years of experience in breast imaging and one in training with > 3 years of experience) assessed all CEUS studies qualitatively in terms of time and intensity of enhancement compared with surrounding tissue, enhancement pattern and size increase after contrast administration, assigning a CEUS score. Further, a combined BI-RADS and CEUS score (CB score) was obtained. Descriptive statistics, AUC (area under the curve), receiver operating characteristic (ROC) analysis, sensitivity and specificity were used to investigate the diagnostic performance of this combined approach.

[RESULTS] A total of 294 lesions in 289 women (mean age 59.8 years; age range 23-88) were analyzed. The average lesion size was 16.6 ± 13.7 mm. Of these, 149 were malignant and 146 benign. CB score showed the highest diagnostic performance compared to CEUS score alone (average AUC = 0.935 vs. 0.890, respectively; p < 0.0001). For the more experienced reader, CB score yielded an AUC of 0.947; for the less experienced reader, AUC was 0.922. Finally, CB score would have obviated up to 40% of unnecessary biopsies.

[CONCLUSION] The combined CEUS and BI-RADS scoring system (CB score) improved diagnostic performance for breast cancer classification and showed high accuracy and consistency across readers with different experience, reducing the rate of unnecessary biopsies.