To explore the value of multimodal ultrasonography in correcting breast imaging reporting and data system (BI-RADS) classification of benign and malignant breast masses.

Conventional ultrasound, ultramicro blood flow imaging, and strain elastography were used to examine 130 consecutive cases of breast masses collected from the Second Affiliated Hospital of Anhui Medical University from July 2021 to December 2021 as a training set. The results of ultramicro blood flow imaging and elastography are expressed as vascular index (VI) and elastic strain (SR) ratio, respectively. Taking the pathological results as the gold standard, the cut-off values of VI and SR for the diagnosis of benign and malignant masses were obtained. Then, 110 consecutive cases of breast masses collected from January to May 2022 were selected as the verification set, BI-RADS grading was performed by conventional ultrasound, and the BI-RADS grading results were corrected by the evaluation results of ultramicroangiography, strain elastography, and artificial intelligence based S-Detect technology. The receiver operating characteristic (ROC) curve was drawn according to the pathological results. The area under the ROC curve (AUC) values of combined diagnosis and independent diagnosis were compared by Z test, and the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of different diagnostic methods were calculated.

Among the 130 cases of breast masses in the training set, 70 were malignant and 60 were benign. The cut-off values of VI and SR were 4.05 and 2.59, respectively. Among the 110 cases of breast masses in the verification set, 63 were malignant and 47 were benign; the AUC values of conventional ultrasound, S-Detect, VI, SR, and their combination in the diagnosis of benign and malignant breast masses were 0.936, 0.588, 0.827, 0.802, and 0.785, respectively, and Z test showed that the efficacy of combined diagnosis was better than that of any independent modality (Z=6.074, P＜0.001; Z=2.668, P=0.008; Z=3.084, P=0.002; Z=3.293, P=0.001). For joint diagnosis, the sensitivity was 98.4%, the specificity was 87.2%, the accuracy was 93.6%, the PPV was 91.2%, and the NPV was 97.6%. According to the 2013 version of American College of Radiology BI-RADS, for ≥ category 4 masses, puncture biopsy should be performed. After correction, the puncture biopsy rate decreased from 87.3% (96/110) to 61.8% (68/110). In addition, 4 cases were found to be misdiagnosed as benign (3 cases of non-special type of invasive breast cancer and 1 case of intraductal carcinoma in situ) and 32 cases were found to be misdiagnosed as malignant (17 cases of adenosis, 14 cases of adenosis with fibroadenoma, and 1 case of phyllodes tumor).

Multimodal ultrasound combined with artificial intelligence-based S-Detect technique to correct BI-RADS classification can improve the diagnostic efficiency for breast masses, reduce unnecessary puncture biopsies, and improve the detection rate for malignant breast masses.