Combining ultrasound gray scale ratio and BI-RADS grading for differentiating benign and malignant breast masses

Abstract

Background

The evaluation of breast mass echo in the breast imaging reporting and data system (BI-RADS) is subjective, whereas ultrasound grayscale ratio (UGSR) provides a quantitative measure of ultrasound echo intensity. The purpose of this study is to investigate the value of UGSR, in conjunction with BI-RADS, for distinguishing between benign and malignant breast masses.

Methods

A retrospective analysis was conducted on ultrasound imaging data from 179 malignant breast mass cases and 219 benign breast mass cases. The masses were categorized according to the BI-RADS grading standard, and the grayscale values of the masses, adjacent fat lobules, and mammary glands were measured using the RADinfo system. The f-UGSR (ratio of ultrasound grayscale of mass to ultrasound grayscale of fat lobule) and g-UGSR (ratio of ultrasound grayscale of mass to ultrasound grayscale of gland) were calculated. The receiver operating characteristic (ROC) curve was constructed, optimal thresholds for f-UGSR and g-UGSR were determined, and the diagnostic efficacy of the combination of f-UGSR, g-UGSR and BI-RADS grading was assessed.

Results

The f-UGSR for malignant and benign breast masses were 0.57 ± 0.20 and 0.85 ± 0.23, respectively, while the g-UGSR were 0.23 (0.18, 0.30) and 0.38 (0.30, 0.47) respectively. The area under the ROC curve (AUC) for f-UGSR and g-UGSR in the diagnosis of breast malignant masses were 0.819 and 0.823, respectively, with the optimal thresholds of 0.69 and 0.29, respectively. The AUC for BI-RADS, g-UGSR, and their combination in the diagnosis of breast malignant masses were 0.849, 0.823, and 0.821, respectively. Sensitivity rates were approximately 74.30%, 73.74%, and 89.39%, and specificity rates were 95.43%, 77.17%, and 74.89%, respectively.

Conclusion

UGSR provides an objective and accurate method to evaluate the benign or malignant nature of breast masses. Combining UGSR with BI-RADS enhances sensitivity, reduces the missed diagnosis rate, and improves confidence in distinguishing between benign and malignant breast masses.