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

BackgroundThe 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.MethodsA 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.ResultsThe 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.ConclusionUGSR 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.