Objective To investigate the image features of breast specific gamma imaging(BSGI) in the differential diagnosis of breast lesions.

Methods A total of 272 Chinese female patients(including 293 lesions) who underwent BSGI between July 2014 to June 2015 were included. Several characteristics of the shape of the lesion, clarity of the boundary, grey scale distribution(the existence of a decentered core), breast imaging reporting and data system(BIRADS), and maximum tumor to non-tumor ratio(T/NT) were recorded. The correlation of each feature with the pathology was evaluated by rank correlation analysis and binary logistic regression analysis. All features were used in the diagnosis of the 293 lesions. Each independent lesion-based diagnostic performance as well as the combined diagnostic efficacy of statistically significant features were evaluated. Using MedCalc software, Z test based on receiver operating characteristic curve was used between each pair of image features to figure out their possible differences.

Results Three imaging features including the shape of the lesion(OR=0.013, 95%CI: 3.664–21.846, P=0.000), the clarity of boundary(OR=2.121, 95%CI: 1.061–4.239, P=0.033), and grey scale distribution(the existence of a decentered core)(OR=12.927, 95%CI: 5.415–30.863, P=0.000) were significantly related with the pathology. The sensitivity and specificity of the three former characteristics were 92.0%(172/187) and 58.5%(62/106), 66.8%(125/187) and 71.7%(76/106), and 95.7%(179/187) and 27.4%(29/106), respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the combined diagnosis of the three former image characteristics were 88.2%(165/187), 81.1%(86/106), 89.2%(165/185), 79.6%(86/108), and 85.7%(251/293), respectively. With the best performance of all, this combined diagnosis has a higher diagnostic performance than BIRADS and maximum T/NT(cutoff ratio:1.75)(Z=4.079 and 4.090, both P<0.05).

Conclusions The shape of the lesion, the clarity of boundary, and the grey-scale distribution(the existence of a decentered core) could be three important differential diagnostic standards of breast lesions in BSGI. With the combined diagnosis of the three features, the efficacy of independent diagnosis of BSGI in breast lesions could be improved.