Diagnostic Efficacy of Contrast-Enhanced Ultrasound for Breast Intraductal Lesions: A Multi-Modal Physician...

To compare the diagnostic efficacy of 3 imaging modalities-conventional ultrasound (US), contrast-enhanced ultrasound (CEUS), and their combination (US + CEUS)-among physicians with varying experience levels in diagnosing breast intraductal lesions and to elucidate the adjunctive value of CEUS.

This study included patients who underwent both US and CEUS for breast lesions and were subsequently pathologically confirmed to have intraductal breast lesions between January 2022 and September 2025. Using pathological findings as the gold standard, the efficacy of senior, mid-career, and junior physicians in differentiating benign from malignant intraductal lesions was calculated and compared across the 3 diagnostic modalities.

A total of 205 cases were included, comprising 117 benign and 88 malignant lesions. The combined US + CEUS approach demonstrated significantly superior diagnostic efficacy and higher diagnostic confidence scores compared to either CEUS or US alone among physicians at all experience levels. The combined modality yielded optimal efficacy in the senior physician group (p < .001), while the magnitude of improvement was greatest among junior physicians (p < .001), particularly for easily missed lesions like atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS). For any given examination protocol, diagnostic efficacy exhibited a declining trend with decreasing physician experience (p < .05).

CEUS serves as a valuable adjunctive tool for diagnosing breast intraductal lesions and is particularly beneficial for junior and mid-career physicians. The combined diagnostic approach enhances overall diagnostic performance.