Improvements of the US BI-RADS Assessment – A Necessity for a Non-Invasive Positive and Differential Diagnosis of Breast Cancer. Application of the New Full Breast Ultrasonography Concept

Objective: Despite the engineering progress, the diagnosis of breast cancer (BC) is unsatisfactory due to less specific descriptors and non-anatomical scanning and interpretation, proving that physicians lag behind technology. We aimed to improve the noninvasive positive and differential diagnosis of BC using modern technology applied to the new integrative concept of Full Breast Ultrasonography (FBU): anatomical radial scanning, color Doppler and Strain Sonoelastography (SE). Methods: We analyzed retrospectively 1841 consecutive FBUs in 1333 patients from screening, diagnosis, or follow-up, in two centers. We searched three descriptors: the ductal connection of the lesions, the incident angle of the plunging artery, and the SE (Ueno score). We compared the initial BI-RADS assessment with pathological reports or follow-up examinations of benign findings. Results: Radial scanning and ductal connection provided a standardized examination of the entire breast, with 100% sensitivity, early detection, precise location, and easy follow-up. We found no correlation BC-Density-Age, but a significant association BC - Benign pathology. The benign lesions, usually multiple, associated the proliferative and secretory types. The incident angle of the plunging artery was the best descriptor for the BC mass-type and associated with a score 4 or 5 Ueno led to PPV of 97.01%, specificity of 99.67%, and accuracy of 99.69%. Inflammatory BC illustrated high glandular strain and diffuse hyperemia. Conclusion: FBU had optimal accuracy, independent of the mammographic model, in screening and diagnosis. The vascular angle correlated with strain SE (adapted to the breast heterogeneity) raised the specificity and is recommended for inclusion in US BI-RADS.