Study on Contrast-Enhanced Ultrasound Combined with Serology in Optimizing the Diagnosis of BI-RADS Category 4 Nodules

Objective: Taking pathological results as the gold standard, this study aimed to analyze the clinical application value of contrast-enhanced ultrasound (CEUS) qualitative features combined with carbohydrate antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA) in improving the diagnostic efficacy for breast imaging reporting and data system (BI-RADS) Category 4 nodules. Methods: A retrospective analysis was conducted on 308 cases of breast BI-RADS Category 4 nodules with pathological results, diagnosed in the Affiliated Hospital of Youjiang Medical University for Nationalities from January 2022 to November 2024. These cases were divided into a malignant group (111 cases) and a benign group (197 cases). The nodules were reclassified according to BI-RADS based on CEUS qualitative features and serological indicators. Receiver operating characteristic (ROC) curves were constructed to compare the differences in diagnostic efficacy between single diagnostic methods and combined diagnostic methods for breast BI-RADS Category 4 nodules. Results: Statistically significant differences were observed between the benign and malignant groups of breast BI-RADS Category 4 nodules in terms of CEUS qualitative features, including enhancement intensity, uniformity of contrast agent distribution, perfusion defect, post-enhancement boundary, enhancement range, and radial convergence (all P<0.05). The levels of CEA, CA15-3, and age in the malignant group were higher than those in the benign group, with statistically significant differences (all P<0.05). Among the indicators, enhancement pattern, post-enhancement boundary, enhancement range, radial convergence, age, and CA15-3 showed relatively better diagnostic efficacy; the combined diagnostic efficacy of these six indicators was the highest, with an area under the curve (AUC) of 0.948, sensitivity of 92.8%, and specificity of 86.3% (95% confidence interval [CI]: 0.924-0.972). Conclusion: The combination of CEUS qualitative features and serological indicators can improve the diagnostic efficacy for breast BI-RADS Category 4 nodules.