To assess the value of scoring by contrast-enhanced ultrasound (CEUS) combined with ultrasonic elastography (UE) in the differential diagnosis of Breast Imaging Reporting and Date System for Ultrasound (BI-RADS-US) 4 lesions.

From April 2012 to February 2016, a total of 172 BI-RADS 4 lesions in 158 patients who underwent CEUS and UE at the Second Affiliated Hospital of Medical College of Zhejiang University were included. The scores of each lesion were evaluated. The diagnostic results were compared with biopsy or operative pathology. ROC curve was used to analyze the value of scoring by CEUS combined with UE in the differential diagnosis of BI-RADS 4 lesions.

Among the 172 lesions, pathological diagnosis showed benign lesions in 80 cases, and malignant lesions in 92. The area under the ROC curve (AUC) of CEUS scoring alone was 0.894, and the sensitivity, specificity, and accuracy were 84.78%, 85.00%, and 84.88%, respectively. The area under the ROC curve (AUC) of UE scoring alone was 0.844, and the sensitivity, specificity, and accuracy were 82.61%, 82.50%, and 82.56%, respectively. When the cut-off value of the score of CEUS combined with UE was set at 7, the AUC was 0.951, and the sensitivity, specificity, and accuracy were 94.57%, 93.75%, and 94.19%, respectively, which were all higher than those of the two modalities alone (P<0.05).

Scoring by CEUS combined with UE can significantly improve the accuracy in the diagnosis of BI-RADS 4 lesions, and it can be used as a supplement to the BI-RADS classification to reduce unnecessary preoperative biopsy.