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Breast Lesions: Imaging with Contrast-enhanced Subharmonic US—Initial Experience¹

¹ From the Departments of Radiology (F.F., C.W.P., D.A.M.) and Pathology (J.J.P.), Thomas Jefferson University, Suite 763J, Main Building, 132 S 10th St, Philadelphia, PA 19107; and GE Healthcare, Milwaukee, Wis (A.L.H.). Received September 13, 2006; revision requested November 9; revision received January 10, 2007; final version accepted February 1. Supported in part by the U.S. Army Medical Research Material Command under DAMD17-00-1-0464 and by GE Healthcare, Princeton, NJ. Address correspondence to F.F. (e-mail: flemming.forsberg{at}jefferson.edu).

Purpose: To prospectively compare accuracy of gray-scale subharmonic imaging (SHI) with that of standard gray-scale ultrasonography (US), power Doppler US (with and without contrast material), and mammography for the diagnosis of breast cancer, with histopathologic or clinical follow-up results as the reference standard.

Materials and Methods: This HIPAA-compliant pilot study had institutional review board approval; all subjects gave written informed consent. Fourteen women (age range, 37–66 years) had 16 biopsy-proved breast lesions. In SHI, pulses are transmitted at one frequency, but only echoes at half that frequency (the subharmonic) are received. A US scanner was modified to perform gray-scale SHI (transmitting at 4.4 and receiving at 2.2 MHz). Precontrast imaging (gray-scale US and power Doppler) was followed by contrast material–enhanced power Doppler and gray-scale SHI. A reader blinded to mammographic and pathologic findings assessed diagnosis on a six-point scale. Sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curves were computed for mammography, gray-scale and power Doppler imaging (pre- and postcontrast), and SHI.

Results: Of the 16 lesions, four (25%) were malignant. Mammography had 100% sensitivity and 20% specificity. Sensitivity and specificity, respectively, were 50% and 92% for precontrast imaging and 75% and 75% for contrast-enhanced power Doppler. SHI had 75% sensitivity and 83% specificity. Specificity was higher for all US modes than for mammography (P < .04). There were no significant differences in specificity among US modes or in sensitivity (P .50). Area under the ROC curve for the diagnosis of breast cancer was 0.64 for standard gray-scale US and power Doppler US, 0.67 for contrast-enhanced power Doppler US, 0.76 for mammography, and 0.78 for SHI (P > .20). Contrast enhancement was better with SHI than with power Doppler (100% vs 44% of lesions with good or excellent enhancement; P = .004).

Conclusion: SHI appears to improve the diagnosis of breast cancer relative to conventional US and mammography, albeit on the basis of results in a very limited number of subjects.

© RSNA, 2007