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Luo J, Tang L, Chen Y, Yang L, Shen R, Cheng Y, Zhang Z, Lv Z, Yuan L, Yang Y, Cheng Y, Bai B, Luo J, Chen Q. A Prospective Multicenter Study on the Additive Value of Contrast-Enhanced Ultrasound for Biopsy Decision of Ultrasound BI-RADS 4 Breast Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1224-1231. [PMID: 38796340 DOI: 10.1016/j.ultrasmedbio.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE The main aim of this study was to determine whether the use of contrast-enhanced ultrasound (CEUS) could improve the categorization of suspicious breast lesions based on the Breast Imaging Reporting and Data System (BI-RADS), thereby reducing the number of benign breast lesions referred for biopsy. METHODS This prospective study, conducted between January 2017 and December 2018, enrolled consenting patients from eight teaching hospitals in China, who had been diagnosed with solid breast lesions classified as BI-RADS 4 using conventional ultrasound. CEUS was performed within 1 wk of diagnosis for reclassification of breast lesions. Histopathological results obtained from core needle biopsies or surgical excision samples served as the reference standard. The simulated biopsy rate and cancer-to-biopsy yield were used to compare the accuracy of CEUS and conventional ultrasound (US). RESULTS Among the 1490 lesions diagnosed as BI-RADS 4 with conventional ultrasound, 486 malignant and 1004 benign lesions were confirmed based on histology. Following CEUS, 2, 395, and 211 lesions were reclassified as CEUS-based BI-RADS 2, 3, and 5, respectively, while 882 (59%) remained as BI-RADS 4. The actual cancer-to-biopsy yield based on US was 32.6%, which increased to 43.4% when CEUS-based BI-RADS 4A was used as the cut-off point to recommend biopsy. The simulated biopsy rate decreased to 73.4%. Overall, in this preselected BI-RADS 4 population, only 2.5% (12/486) of malignant lesions would have been miscategorized as BI-RADS 3 using CEUS-based reclassification. The diagnostic accuracy, sensitivity, and specificity of contrast-enhanced ultrasound reclassification were 57.65%, 97.53%, and 38.35%, respectively. CONCLUSION Our collective findings indicate that CEUS is a valuable tool in further triage of BI-RADS category 4 lesions and facilitates a reduction in the number of biopsies while increasing the cancer-to-biopsy yield.
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Affiliation(s)
- Jun Luo
- Ultrasound Department, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Lina Tang
- Department of Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yijie Chen
- Department of Ultrasound, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Lichun Yang
- Department of Ultrasound, the Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Hospital, Kunming, China
| | - Ruoxia Shen
- Department of Ultrasound, the Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Hospital, Kunming, China
| | - Yan Cheng
- Department of Ultrasound, Qujing City First People's Hospital, Qujing, China
| | - Zizhen Zhang
- Department of Ultrasound, Qujing City First People's Hospital, Qujing, China
| | - Zhihong Lv
- Department of Ultrasound, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group, Huangshi, China
| | - Lijun Yuan
- Departments of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yong Yang
- Departments of Ultrasound, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yinrong Cheng
- Department of Ultrasound, Chengdu First People's Hospital, Chengdu, China
| | - Baoyan Bai
- Department of Ultrasound, Yanan University Affiliated Hospital, Yan'an, China
| | - Jing Luo
- Department of Breast Surgery, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Qin Chen
- Ultrasound Department, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China.
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Sugar BP, Thomas JM, Beutler BD, Clifford TG, Tchelepi H. Contrast-enhanced ultrasound (CEUS) for the characterization of intra-scrotal lesions. Eur J Radiol 2024; 175:111453. [PMID: 38598965 DOI: 10.1016/j.ejrad.2024.111453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/16/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging modality for the characterization of hepatic and renal lesions. However, there is a paucity of data describing the use of CEUS for the evaluation of intra-scrotal pathology. In the following review, we describe the clinical utility of CEUS for the characterization and differentiation of common and uncommon intra-scrotal conditions, including testicular torsion, infection, trauma, and benign and malignant intratesticular and extratesticular neoplasms. In addition, we outline key principles of CEUS and provide case examples from our institution.
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Affiliation(s)
- Benjamin P Sugar
- University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Jerry M Thomas
- University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States.
| | - Thomas G Clifford
- University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, United States
| | - Hisham Tchelepi
- Los Angeles General Medical Center, Los Angeles, CA 90033, United States
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Zhang J, Zhang Y, Cai Z, Wei J, Li H, Li P, Dong X, Liu Z. Augmentation of tumour perfusion by ultrasound and microbubbles: A preclinical study. ULTRASONICS 2024; 138:107219. [PMID: 38104380 DOI: 10.1016/j.ultras.2023.107219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/05/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Hypoperfusion and the resulting hypoxia in solid tumours are critical causes of treatment resistance. Ultrasound-stimulated microbubbles (USMB) enhance tumour perfusion in a mechanism named the "sononeoperfusion" effect, which may relieve tumour hypoperfusion and hypoxia. The aim of this study was to determine the optimal mechanical index (MI) and therapeutic ultrasound exposure time for the sononeoperfusion effect and preliminarily explore the mechanism of sononeoperfusion and its effect on tumours. METHODS A total of 155 mice bearing MC38 tumours were included in this study. A modified diagnostic ultrasound and microbubbles (Zhifuxian) was used for USMB treatment. Tumour perfusion was evaluated by contrast-enhanced ultrasound (CEUS) and Hoechst 33342. The therapeutic pulse was operated with MIs of 0.1 to 0.5. The ultrasound exposure time was set from 150 s to 600 s. Endothelial nitric oxide synthase (eNOS) inhibition and NO, ATP, and phospho-eNOS (p-eNOS) detection were performed to explore the mechanisms of sononeoperfusion. Hypoxia-inducible factor-1α (HIF-1α) and tumour oxygen partial pressure (pO2) represent hypoxic tumour conditions. RESULTS Tumour perfusion was increased after USMB treatment at MIs of 0.1-0.4 and ultrasound exposure times of 150 s to 600 s, with optimal augmentation achieved at an MI of 0.3 and ultrasound exposure time of 450 s. The mean fluorescence intensity of Hoechst 33342 after USMB treatment was stronger than that of the control group. Biochemical assays showed a significant increase in ATP, p-eNOS and NO after USMB treatment. PO2 in tumour tissue increased significantly after USMB treatment and was maintained for more than 20 min. CONCLUSIONS The best sononeoperfusion effect was obtained with an MI of 0.3 and an ultrasound exposure time of 450 s. The effect is most likely related to NO and ATP increases. The sononeoperfusion effect might be a novel way to ameliorate tumour hypoperfusion and hypoxia.
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Affiliation(s)
- Jing Zhang
- Department of Ultrasound, Xinqiao Hospital, Army Medical University Chongqing, 400037, China
| | - Yi Zhang
- Department of Ultrasound, Xinqiao Hospital, Army Medical University Chongqing, 400037, China
| | - Zhiping Cai
- Department of Ultrasound, Xinqiao Hospital, Army Medical University Chongqing, 400037, China
| | - Junshuai Wei
- Department of Ultrasound, Xinqiao Hospital, Army Medical University Chongqing, 400037, China
| | - Hui Li
- Department of Ultrasound, Xinqiao Hospital, Army Medical University Chongqing, 400037, China
| | - Peijing Li
- Department of Ultrasound, Xinqiao Hospital, Army Medical University Chongqing, 400037, China
| | - Xiaoxiao Dong
- Department of Ultrasound, Xinqiao Hospital, Army Medical University Chongqing, 400037, China.
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, Army Medical University Chongqing, 400037, China.
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Yang Q, Fu Y, Wang J, Yang H, Zhang X. Advantages of contrast-enhanced ultrasound in the localization and diagnostics of sentinel lymph nodes in breast cancer. J Zhejiang Univ Sci B 2023; 24:985-997. [PMID: 37961801 PMCID: PMC10646391 DOI: 10.1631/jzus.b2300019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/21/2023] [Indexed: 11/15/2023]
Abstract
Sentinel lymph nodes (SLNs) are the first station of lymph nodes that extend from the breast tumor to the axillary lymphatic drainage. The pathological status of these LNs can predict that of the entire axillary lymph node. Therefore, the accurate identification of SLNs is necessary for sentinel lymph node biopsy (SLNB) to replace axillary lymph node dissection (ALND). The quality of life and prognosis of breast cancer patients are related to proper surgical treatment after the precise identification of SLNs. Some of the SLN tracers that have been identified include radioisotope, nano-carbon, indocyanine green (ICG), and methylene blue (MB). However, these tracers have certain limitations, such as pigmentation, radiation dangers, and the requirement for costly detection equipment. Ultrasound contrast agents (UCAs) have good specificity and sensitivity, and thus can compensate for some shortcomings of the mentioned tracers. This technique is also being applied to SLNB in patients with breast cancer, and can even provide an initial judgment on SLN status. Contrast-enhanced ultrasound (CEUS) has the advantages of high distinguishability, simple operation, no radiation harm, low cost, and accurate localization; therefore, it is expected to replace the traditional biopsy methods. In addition, it can significantly enhance the accuracy of SLN localization and shorten the operation time.
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Affiliation(s)
- Qiuhui Yang
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou 310022, China
| | - Yeqin Fu
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou 310022, China
| | - Jiaxuan Wang
- The First Clinical Medical College, Shanxi Medical University, Jinzhong 030600, China
| | - Hongjian Yang
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China.
| | - Xiping Zhang
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou 310022, China. ,
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Li H, He H, Tang J, Luo T, Yang G, Huang L, Dong X, Liu Z. A new sonoablation using acoustic droplet vaporization and focused ultrasound: A feasibility study. Med Phys 2023; 50:6663-6672. [PMID: 37731063 DOI: 10.1002/mp.16742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Histotripsy and boiling histotripsy are two methods of mechanical ablation that use high-pressure focused ultrasound (FUS). PURPOSE Here, a new bubble sonoablation technique was investigated using low-pressure FUS in combination with local injection of perfluoropentane (PFP) in rabbit liver. METHODS Fifteen healthy New Zealand white rabbits were treated with FUS alone, FUS + PFP or PFP alone. FUS was performed using a single-element focused transducer (frequency 596 kHz, 0.27 ms pulses, 0.54% duty cycle, and peak negative pressure 2.0 MPa). Ten minutes before FUS treatment, the PFP droplet was locally injected into the rabbit liver, where the ultrasound was focused. Contrast-enhanced ultrasound (CEUS) of the liver was performed, and the temperature at the liver surface in the targeted liver region was recorded during treatment. The livers were collected for pathological examination. Statistical significance was set at p < 0.05. Paired t-tests were used to compare the pre- and post-treatment values. One-way analysis of variance was performed to compare multiple groups, and the least significant difference method was used for further comparisons between the two groups. RESULTS Analysis of CEUS data showed that the values of area under the curve (AUC) were significantly different in the PFP + FUS group pre- (10453.644 ± 1182.93) and post-treatment (4058.098 ± 2720.41), and the AUC values of PFP + FUS post-treatment (4058.098 ± 2720.41) were also significantly lower than those of the FUS (9946.694 ± 1071.54) and the PFP (10364.794 ± 2181.53) groups. The peak intensity values also showed the same results, the value of peak intensity of PFP+FUS post-treatment was 82.958 ± 13.99, whereas there was no difference between FUS (106.61 ± 7.61) and PFP (104.136 ± 10.55). Hematoxylin and eosin (H&E) staining revealed that the pathological damage ratings of the PFP + FUS, PFP, and FUS groups were grade 3, grade 1, and grade 0, respectively. Specifically, the area of liver necrosis in the PFP + FUS group (0.99 ± 0.29 cm2 ) was 198 times higher than that in the PFP group (0.005 ± 0.008 cm2 ), whereas no necrosis was observed in the livers treated with FUS alone. Simultaneously, the number of vacuoles in the liver of the PFP + FUS group (35.50 ± 23.31) was approximately five times that of the PFP group (7.00 ± 12.88), whereas no vacuoles were found in the liver treated with FUS alone. CONCLUSION PFP droplets combined with FUS can destroy liver tissue and cause tissue necrosis in the droplet injection area, without affecting the structure of surrounding tissue.
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Affiliation(s)
- Hui Li
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Huan He
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jiawei Tang
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Tingting Luo
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Guoliang Yang
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Leidan Huang
- Department of Ultrasound, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xiaoxiao Dong
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zheng Liu
- Department of Ultrasound, The Second Affiliated Hospital of Army Medical University, Chongqing, China
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Wang Y, Xu Z, Tang L, Zhang Q, Chen M. The Clinical Application of Artificial Intelligence Assisted Contrast-Enhanced Ultrasound on BI-RADS Category 4 Breast Lesions. Acad Radiol 2023; 30 Suppl 2:S104-S113. [PMID: 37095048 DOI: 10.1016/j.acra.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 04/26/2023]
Abstract
RATIONALE AND OBJECTIVES To propose a novel deep learning method incorporating multiple regions based on contrast-enhanced ultrasound and grayscale ultrasound, evaluate its performance in reducing false positives for Breast Imaging Reporting and Data System (BI-RADS) category 4 lesions, and compare its diagnostic performance with that of ultrasound experts. MATERIALS AND METHODS This study enrolled 163 breast lesions in 161 women from November 2018 to March 2021. Contrast-enhanced ultrasound and conventional ultrasound were performed before surgery or biopsy. A novel deep learning model incorporating multiple regions based on contrast-enhanced ultrasound and grayscale ultrasound was proposed for minimizing the number of false-positive biopsies. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy were compared between the deep learning model and ultrasound experts. RESULTS The AUC, sensitivity, specificity, and accuracy of the deep learning model in BI-RADS category 4 lesions were 0.910, 91.5%, 90.5%, and 90.8%, respectively, compared with those of ultrasound experts were 0.869, 89.4%, 84.5%, and 85.9%, respectively. CONCLUSION The novel deep learning model we proposed had a diagnostic accuracy comparable to that of ultrasound experts, showing the potential to be clinically useful in minimizing the number of false-positive biopsies.
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Affiliation(s)
- Yuqun Wang
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Zhou Xu
- The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Lei Tang
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China
| | - Qi Zhang
- The SMART (Smart Medicine and AI-based Radiology Technology) Lab, Shanghai Institute for Advanced Communication and Data Science, Shanghai University, Shanghai, China; School of Communication and Information Engineering, Shanghai University, Shanghai, China
| | - Man Chen
- Department of Ultrasound Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China.
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Barr RG. The Urgent Need for FDA to Approve a Whole-Body Application of Ultrasound Contrast Agents. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:761-764. [PMID: 36029297 DOI: 10.1002/jum.16092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA
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Barbagianni MS, Gouletsou PG. Modern Imaging Techniques in the Study and Disease Diagnosis of the Mammary Glands of Animals. Vet Sci 2023; 10:vetsci10020083. [PMID: 36851387 PMCID: PMC9965774 DOI: 10.3390/vetsci10020083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
The study of the structure and function of the animals' mammary glands is of key importance, as it reveals pathological processes at their onset, thus contributing to their immediate treatment. The most frequently studied mammary diseases are mastitis in cows and ewes and mammary tumours in dogs and cats. Various imaging techniques such as computed tomography, positron emission tomography, magnetic resonance imaging, and ultrasonographic techniques (Doppler, contrast-enchanced, three-dimensional and elastography) are available and can be applied in research or clinical practice in order to evaluate possible abnormalities in mammary glands, as well as to assist in the differential diagnosis. In this review, the above imaging technologies are described, and the perspectives of each method are highlighted. It is inferred that ultrasonographic modalities are the most frequently used imaging techniques for the diagnosis of clinical or subclinical mastitis and treatment guidance on a farm. In companion animals, a combination of imaging techniques should be applied for a more accurate diagnosis of mammary tumours. In any case, the confirmation of the diagnosis is provided by laboratory techniques.
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Luo T, Bai L, Zhang Y, Huang L, Li H, Gao S, Dong X, Li N, Liu Z. Optimal treatment occasion for ultrasound stimulated microbubbles in promoting gemcitabine delivery to VX2 tumors. Drug Deliv 2022; 29:2796-2804. [PMID: 36047064 PMCID: PMC9448370 DOI: 10.1080/10717544.2022.2115163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Ultrasound stimulated microbubbles (USMB) is a widely used technology that can promote chemotherapeutic delivery to tumors yet the best treatment occasion for USMB is unknown or ignored. We aimed to determine the optimal treatment occasion for USMB treatment to enhance tumor chemotherapy to achieve the highest drug concentration in tumors. Experiments were conducted on VX2 tumors implanted in 60 rabbits. Gemcitabine (GEM) was intravenously infused as a chemotherapeutic agent and USMB was administered before, during or after chemotherapy. USMB was conducted with a modified diagnostic ultrasound at 3 MHz employing short bursts (5 cycles and 0.125% duty cycle) at 0.26 MPa in combination with a lipid microbubble. Subsequently, tumor blood perfusion quantitation, drug concentration detection, and fluorescence microscopy were performed. The results showed that the group that received USMB treatment immediately after GEM infusion had the highest drug concentration in tumors, which was 2.83 times that of the control group. Fifteen tumors were then treated repeatedly with the optimal USMB-plus-GEM combination, and along with the GEM and the control groups, were studied for tumor growth, tumor cell proliferation, apoptosis, and related cytokine contents. The combined treatment significantly inhibited tumor growth and promoted apoptosis. The levels of related cytokines, including HIF-1α, decreased after six combination therapies. These results suggest that the optimal treatment occasion for USMB occurs immediately after chemotherapy and tumor hypoxia improves after multiple combination therapies.
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Affiliation(s)
- Tingting Luo
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Luhua Bai
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi Zhang
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Leidan Huang
- Department of Ultrasound, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Hui Li
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shunji Gao
- Department of Ultrasound, General Hospital of Central Theatre Command, Wuhan, China
| | - Xiaoxiao Dong
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ningshan Li
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zheng Liu
- Department of Ultrasound, Xinqiao Hospital, Army Medical University, Chongqing, China
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Guo W, Wang T, Li F, Jia C, Zheng S, Zhang X, Bai M. Non-mass Breast Lesions: Could Multimodal Ultrasound Imaging Be Helpful for Their Diagnosis? Diagnostics (Basel) 2022; 12:diagnostics12122923. [PMID: 36552930 PMCID: PMC9777234 DOI: 10.3390/diagnostics12122923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: To develop a prediction model for discriminating malignant from benign breast non-mass-like lesions (NMLs) using conventional ultrasound (US), strain elastography (SE) of US elastography and contrast-enhanced ultrasound (CEUS). Methods: A total of 101 NMLs from 100 patients detected by conventional US were enrolled in this retrospective study. The characteristics of NMLs in conventional US, SE and CEUS were compared between malignant and benign NMLs. Histopathological results were used as the reference standard. Binary logistic regression analysis was performed to identify the independent risk factors. A multimodal method to evaluate NMLs based on logistic regression was developed. The diagnostic performance of conventional US, US + SE, US + CEUS and the combination of these modalities was evaluated and compared. Results: Among the 101 lesions, 50 (49.5%) were benign and 51 (50.5%) were malignant. Age ≥45 y, microcalcifications in the lesion, elasticity score >3, earlier enhancement time and hyper-enhancement were independent diagnostic indicators included to establish the multimodal prediction method. The area under the receiver operating characteristic curve (AUC) of US + SE + CEUS was significantly higher than that of US (p < 0.0001) and US + SE (p < 0.0001), but there was no significant difference between the AUC of US + SE + CEUS and the AUC of US + CEUS (p = 0.216). Conclusion: US + SE + CEUS and US + CEUS could significantly improve the diagnostic efficiency and accuracy of conventional US in the diagnosis of NMLs.
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Affiliation(s)
- Wenjuan Guo
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Tong Wang
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Siqi Zheng
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xuemei Zhang
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Min Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
- Correspondence:
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Chen J, Ma J, Li C, Shao S, Su Y, Wu R, Yao M. Multi-parameter ultrasonography-based predictive model for breast cancer diagnosis. Front Oncol 2022; 12:1027784. [PMID: 36465370 PMCID: PMC9714455 DOI: 10.3389/fonc.2022.1027784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/01/2022] [Indexed: 12/31/2023] Open
Abstract
OBJECTIVES To develop, validate, and evaluate a predictive model for breast cancer diagnosis using conventional ultrasonography (US), shear wave elastography (SWE), and contrast-enhanced US (CEUS). MATERIALS AND METHODS This retrospective study included 674 patients with 674 breast lesions. The data, a main and an independent datasets, were divided into three cohorts. Cohort 1 (80% of the main dataset; n = 448) was analyzed by logistic regression analysis to identify risk factors and establish the predictive model. The area under the receiver operating characteristic curve (AUC) was analyzed in Cohort 2 (20% of the main dataset; n = 119) to validate and in Cohort 3 (the independent dataset; n = 107) to evaluate the predictive model. RESULTS Multivariable regression analysis revealed nine independent breast cancer risk factors, including age > 40 years; ill-defined margin, heterogeneity, rich blood flow, and abnormal axillary lymph nodes on US; enhanced area enlargement, contrast agent retention, and irregular shape on CEUS; mean SWE higher than the cutoff value (P < 0.05 for all). The diagnostic performance of the model was good, with AUC values of 0.847, 0.857, and 0.774 for Cohorts 1, 2, and 3, respectively. The model increased the diagnostic specificity (from 31% to 81.3% and 7.3% to 73.1% in cohorts 2 and 3, respectively) without a significant loss in sensitivity (from 100.0% to 90.1% and 100.0% to 81.8% in cohorts 2 and 3, respectively). CONCLUSION The multi-parameter US-based model showed good performance in breast cancer diagnosis, improving specificity without a significant loss in sensitivity. Using the model could reduce unnecessary biopsies and guide clinical diagnosis and treatment.
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Affiliation(s)
| | | | | | | | | | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minghua Yao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhang G, Lei YM, Li N, Yu J, Jiang XY, Yu MH, Hu HM, Zeng SE, Cui XW, Ye HR. Ultrasound super-resolution imaging for differential diagnosis of breast masses. Front Oncol 2022; 12:1049991. [PMID: 36408165 PMCID: PMC9669901 DOI: 10.3389/fonc.2022.1049991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE Ultrasound imaging has been widely used in breast cancer screening. Recently, ultrasound super-resolution imaging (SRI) has shown the capability to break the diffraction limit to display microvasculature. However, the application of SRI on differential diagnosis of breast masses remains unknown. Therefore, this study aims to evaluate the feasibility and clinical value of SRI for visualizing microvasculature and differential diagnosis of breast masses. METHODS B mode, color-Doppler flow imaging (CDFI) and contrast-enhanced ultrasound (CEUS) images of 46 patients were collected respectively. SRI were generated by localizations of each possible contrast signals. Micro-vessel density (MVD) and microvascular flow rate (MFR) were calculated from SRI and time to peak (TTP), peak intensity (PI) and area under the curve (AUC) were obtained by quantitative analysis of CEUS images respectively. Pathological results were considered as the gold standard. Independent chi-square test and multivariate logistic regression analysis were performed using these parameters to examine the correlation. RESULTS The results showed that SRI technique could be successfully applied on breast masses and display microvasculature at a significantly higher resolution than the conventional CDFI and CEUS images. The results showed that the PI, AUC, MVD and MFR of malignant breast masses were significantly higher than those of benign breast masses, while TTP was significantly lower than that of benign breast masses. Among all five parameters, MVD showed the highest positive correlation with the malignancy of breast masses. CONCLUSIONS SRI is able to successfully display the microvasculature of breast masses. Compared with CDFI and CEUS, SRI can provide additional morphological and functional information for breast masses. MVD has a great potential in assisting the differential diagnosis of breast masses as an important imaging marker.
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Affiliation(s)
- Ge Zhang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
| | - Yu-Meng Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Nan Li
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Jing Yu
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Xian-Yang Jiang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Mei-Hui Yu
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Hai-Man Hu
- Department of Electrical and Electronic Engineering, Hubei University of Technology, Wuhan, China
| | - Shu-E Zeng
- Department of Medical Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hua-Rong Ye
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
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Ternifi R, Wang Y, Gu J, Polley EC, Carter JM, Pruthi S, Boughey JC, Fazzio RT, Fatemi M, Alizad A. Ultrasound high-definition microvasculature imaging with novel quantitative biomarkers improves breast cancer detection accuracy. Eur Radiol 2022; 32:7448-7462. [PMID: 35486168 PMCID: PMC9616967 DOI: 10.1007/s00330-022-08815-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To overcome the limitations of power Doppler in imaging angiogenesis, we sought to develop and investigate new quantitative biomarkers of a contrast-free ultrasound microvasculature imaging technique for differentiation of benign from malignant pathologies of breast lesion. METHODS In this prospective study, a new high-definition microvasculature imaging (HDMI) was tested on 521 patients with 527 ultrasound-identified suspicious breast masses indicated for biopsy. Four new morphological features of tumor microvessels, microvessel fractal dimension (mvFD), Murray's deviation (MD), bifurcation angle (BA), and spatial vascularity pattern (SVP) as well as initial biomarkers were extracted and analyzed, and the results correlated with pathology. Multivariable logistic regression analysis was used to study the performance of different prediction models, initial biomarkers, new biomarkers, and combined new and initial biomarkers in differentiating benign from malignant lesions. RESULTS The new HDMI biomarkers, mvFD, BA, MD, and SVP, were statistically significantly different in malignant and benign lesions, regardless of tumor size. Sensitivity and specificity of the new biomarkers in lesions > 20 mm were 95.6% and 100%, respectively. Combining the new and initial biomarkers together showed an AUC, sensitivity, and specificity of 97% (95% CI: 95-98%), 93.8%, and 89.2%, respectively, for all lesions regardless of mass size. The classification was further improved by adding the Breast Imaging Reporting and Data System (BI-RADS) score to the prediction model, showing an AUC, sensitivity, and specificity of 97% (95% CI: 95-98%), 93.8%, and 89.2%, respectively. CONCLUSION The addition of new quantitative HDMI biomarkers significantly improved the accuracy in breast lesion characterization when used as a complementary imaging tool to the conventional ultrasound. KEY POINTS • Novel quantitative biomarkers extracted from tumor microvessel images increase the sensitivity and specificity in discriminating malignant from benign breast masses. • New HDMI biomarkers Murray's deviation, bifurcation angles, microvessel fractal dimension, and spatial vascularity pattern outperformed the initial biomarkers. • The addition of BI-RADS scores based on US descriptors to the multivariable analysis using all biomarkers remarkably increased the sensitivity, specificity, and AUC in all size groups.
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Affiliation(s)
- Redouane Ternifi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Yinong Wang
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Juanjuan Gu
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric C Polley
- Department of Health Science, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sandhya Pruthi
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA.
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Varghese BA, Lee S, Cen S, Talebi A, Mohd P, Stahl D, Perkins M, Desai B, Duddalwar VA, Larsen LH. Characterizing breast masses using an integrative framework of machine learning and CEUS-based radiomics. J Ultrasound 2022; 25:699-708. [PMID: 35040103 PMCID: PMC9402818 DOI: 10.1007/s40477-021-00651-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/14/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS We evaluated the performance of contrast-enhanced ultrasound (CEUS) based on radiomics analysis to distinguish benign from malignant breast masses. METHODS 131 women with suspicious breast masses (BI-RADS 4a, 4b, or 4c) who underwent CEUS examinations (using intravenous injection of perflutren lipid microsphere or sulfur hexafluoride lipid-type A microspheres) prior to ultrasound-guided biopsies were retrospectively identified. Post biopsy pathology showed 115 benign and 16 malignant masses. From the cine clip of the CEUS exams obtained using the built-in GE scanner software, breast masses and adjacent normal tissue were then manually segmented using the ImageJ software. One frame representing each of the four phases: precontrast, early, peak, and delay enhancement were selected post segmentation from each CEUS clip. 112 radiomic metrics were extracted from each segmented tissue normalized breast mass using custom Matlab® code. Linear and nonlinear machine learning (ML) methods were used to build the prediction model to distinguish benign from malignant masses. tenfold cross-validation evaluated model performance. Area under the curve (AUC) was used to quantify prediction accuracy. RESULTS Univariate analysis found 35 (38.5%) radiomic variables with p < 0.05 in differentiating between benign from malignant masses. No feature selection was performed. Predictive models based on AdaBoost reported an AUC = 0.72 95% CI (0.56, 0.89), followed by Random Forest with an AUC = 0.71 95% CI (0.56, 0.87). CONCLUSIONS CEUS based texture metrics can distinguish between benign and malignant breast masses, which can, in turn, lead to reduced unnecessary breast biopsies.
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Affiliation(s)
- Bino A Varghese
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA.
| | - Sandy Lee
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
| | - Steven Cen
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
| | - Amir Talebi
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
| | - Passant Mohd
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
| | - Daniel Stahl
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
| | - Melissa Perkins
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
| | - Bhushan Desai
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
| | - Vinay A Duddalwar
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
| | - Linda H Larsen
- Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Ground Floor, G360, Los Angeles, CA, 90033, USA
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Wang H, Feng D, Zou T, Liu Y, Wu X, Zou J, Huang R. Contrast-enhanced ultrasound of granular cell tumor in breast: A case report with review of the literature. Front Oncol 2022; 12:894261. [PMID: 36081553 PMCID: PMC9445188 DOI: 10.3389/fonc.2022.894261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Granular cell tumor is an infrequent, predominantly benign tumor originating from Schwann cells. Granular cell tumor of the breast (GCTB) can simulate breast malignant carcinoma on the clinical assessment. We herein present a rare case of GCTB which recurred in the contralateral breast. We believe the contrast-enhanced ultrasound (CEUS) findings of GCTB have never been described. The high similarity of breast malignant carcinoma makes its differential diagnosis difficult on the clinical and radiological features. In this report, we present the CEUS findings from a rare case of GCTB, explore the possible value of CEUS in differential diagnosis between benign breast lesions and malignant ones, and briefly review the literature.
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Affiliation(s)
- Huanyu Wang
- Department of Breast and Thyroid Surgery, Huazhong University of Science and Technology Shenzhen Union Hospital, Shenzhen, China
| | - Duo Feng
- Department of Breast and Thyroid Surgery, Huazhong University of Science and Technology Shenzhen Union Hospital, Shenzhen, China
| | - Tianhui Zou
- Department of Breast and Thyroid Surgery, Huazhong University of Science and Technology Shenzhen Union Hospital, Shenzhen, China
| | - Yao Liu
- Department of Breast and Thyroid Surgery, Huazhong University of Science and Technology Shenzhen Union Hospital, Shenzhen, China
| | - Xiaoqin Wu
- Department of Breast and Thyroid Surgery, Huazhong University of Science and Technology Shenzhen Union Hospital, Shenzhen, China
| | - Jiawei Zou
- Department of Breast and Thyroid Surgery, Huazhong University of Science and Technology Shenzhen Union Hospital, Shenzhen, China
| | - Rong Huang
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
- *Correspondence: Rong Huang,
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16
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Wang J, Zhao R, Cheng J. Diagnostic accuracy of contrast-enhanced ultrasound to differentiate benign and malignant breast lesions: A systematic review and meta-analysis. Eur J Radiol 2022; 149:110219. [DOI: 10.1016/j.ejrad.2022.110219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
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17
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Chen J, Li CX, Shao SH, Yao MH, Su YJ, Wu R. The association between conventional ultrasound and contrast-enhanced ultrasound appearances and pathological features in small breast cancer. Clin Hemorheol Microcirc 2021; 80:413-422. [PMID: 34842181 DOI: 10.3233/ch-211291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the association between ultrasound appearances and pathological features in small breast cancer. MATERIALS AND METHODS A total of 186 small breast cancers in 186 patients were analyzed in this retrospective study from January 2015 to December 2019 according to pathological results. Forty-seven cases of axillary lymph node metastasis were found. All patients underwent radical axillary surgery following conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) examinations. The association between ultrasound appearances and pathological features was analyzed using univariate distributions and multivariate analysis. Then, a logistic regression model was established using the pathological diagnosis of lymph node metastasis and biochemical indicators as the dependent variable and the ultrasound appearances as independent variables. RESULTS In small breast cancer, risk factors of axillary lymph node metastasis were crab claw-like enhancement on CEUS and abnormal axillary lymph nodes on US. The logistic regression model was established as follows: (axillary lymph node metastasis) = 1.100×(crab claw-like enhancement of CEUS) + 2.749×(abnormal axillary lymph nodes of US) -5.790. In addition, irregular shape on CEUS and posterior echo attenuation on US were risk factors for both positive estrogen receptor and progesterone receptor expression, whereas calcification on US was a risk factor for positive Her-2 expression. A specific relationship could be found using the following logistic models: (positive ER expression) = 1.367×(irregular shape of CEUS) + 1.441×(posterior echo attenuation of US) -5.668; (positive PR expression) = 1.265×(irregular shape of CEUS) + 1.136×(posterior echo attenuation of US) -4.320; (positive Her-2 expression) = 1.658×(calcification of US) -0.896. CONCLUSION Logistic models were established to provide significant value for the prediction of pre-operative lymph node metastasis and positive biochemical indicators, which may guide clinical treatment.
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Affiliation(s)
- Jing Chen
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun-Xiao Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Si-Hui Shao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming-Hua Yao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Jin Su
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Bahl M. Probably Benign on Screening Ultrasound: New Data Call for New Rules. JOURNAL OF BREAST IMAGING 2021; 3:539-541. [PMID: 38424952 DOI: 10.1093/jbi/wbab064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 03/02/2024]
Affiliation(s)
- Manisha Bahl
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
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19
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Quantification of dynamic contrast-enhanced ultrasound (CEUS) in non-cystic breast lesions using external perfusion software. Sci Rep 2021; 11:17677. [PMID: 34480040 PMCID: PMC8417292 DOI: 10.1038/s41598-021-96137-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/05/2021] [Indexed: 12/14/2022] Open
Abstract
The aim of this present clinical pilot study is the display of typical perfusion results in patients with solid, non-cystic breast lesions. The lesions were characterized using contrast enhanced ultrasound (CEUS) with (i) time intensity curve analyses (TIC) and (ii) parametric color maps. The 24 asymptomatic patients included were genetically tested for having an elevated risk for breast cancer. At a center of early detection of familial ovary and breast cancer, those patients received annual MRI and grey-scale ultrasound. If lesions remained unclear or appeared even suspicious, those patients also received CEUS. CEUS was performed after intravenous application of sulfur hexafluoride microbubbles. Digital DICOM cine loops were continuously stored for one minute in PACS (picture archiving and communication system). Perfusion images and TIC analyses were calculated off-line with external perfusion software (VueBox). The lesion diameter ranged between 7 and 15 mm (mean 11 ± 3 mm). Five hypoechoic irregular lesions were scars, 6 lesions were benign and 12 lesions were highly suspicious for breast cancer with irregular enhancement at the margins and a partial wash out. In those 12 cases, histopathology confirmed breast cancer. All the suspicious lesions were correctly identified visually. For the perfusion analysis only Peak Enhancement (PE) and Area Under the Curve (AUC) added more information for correctly identifying the lesions. Typical for benign lesions is a prolonged contrast agent enhancement with lower PE and prolonged wash out, while scars are characterized typically by a reduced enhancement in the center. No differences (p = 0.428) were found in PE in the center of benign lesions (64.2 ± 28.9 dB), malignant lesions (88.1 ± 93.6 dB) and a scar (40.0 ± 17.0 dB). No significant differences (p = 0.174) were found for PE values at the margin of benign lesions (96.4 ± 144.9 dB), malignant lesions (54.3 ± 86.2 dB) or scar tissue (203.8 ± 218.9 dB). Significant differences (p < 0.001) were found in PE of the surrounding tissue when comparing benign lesions (33.6 ± 25.2 dB) to malignant lesions (15.7 ± 36.3 dB) and scars (277.2 ± 199.9 dB). No differences (p = 0.821) were found in AUC in the center of benign lesions (391.3 ± 213.7), malignant lesions (314.7 ± 643.9) and a scar (213.1 ± 124.5). No differences (p = 0.601) were found in AUC values of the margin of benign lesions (313.3 ± 372.8), malignant lesions (272.6 ± 566.4) or scar tissue (695.0 ± 360.6). Significant differences (p < 0.01) were found in AUC of the surrounding tissue for benign lesions (151.7 ± 127.8), malignant lesions (177.9 ± 1345.6) and scars (1091 ± 693.3). There were no differences in perfusion evaluation for mean transit time (mTT), rise time (RT) and time to peak (TTP) when comparing the center to the margins and the surrounding tissue. The CEUS perfusion parameters PE and AUC allow a very good assessment of the risk of malignant breast lesions and thus a downgrading of BI-RADS 4 lesions. The use of the external perfusion software (VueBox, Bracco, Milan, Italy) did not lead to any further improvement in the diagnosis of suspicious breast lesions and does appears not to have any additional diagnostic value in breast lesions.
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Berg WA. BI-RADS 3 on Screening Breast Ultrasound: What Is It and What Is the Appropriate Management? JOURNAL OF BREAST IMAGING 2021; 3:527-538. [PMID: 34545351 PMCID: PMC8445238 DOI: 10.1093/jbi/wbab060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Indexed: 12/24/2022]
Abstract
US is widely used in breast imaging for diagnostic purposes and is also used increasingly for supplemental screening in women with dense breasts. US frequently depicts masses that are occult on mammography, even after tomosynthesis, and the vast majority of such masses are benign. Many masses seen only on screening US are easily recognized as benign simple cysts. Probably benign, BI-RADS 3, or low suspicion, BI-RADS 4A masses are also common and often prompt short-interval follow-up or biopsy, respectively, yet the vast majority of these are benign. This review details appropriate characterization, classification, and new approaches to the management of probably benign masses seen on screening US that can reduce false positives and, thereby, reduce costs and patient anxiety.
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Affiliation(s)
- Wendie A Berg
- University of Pittsburgh School of Medicine, Department of Radiology, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
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21
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Abstract
In multimodal radiologic imaging, contrast-enhanced ultrasound (CEUS) is increasingly used. One of the advantages of CEUS is the possibility of repeated application of contrast media without decreasing renal function or affecting the thyroid gland. Small solid liver lesions can be diagnosed and detected with high accuracy. Moreover, solid lesions in other abdominal organs can also be characterized. Frequent applications for solid lesions in the near field concern thyroid tumors and lymph nodes. For prostate diagnostics, CEUS can be used with an endorectal probe and perfusion imaging. This review explains how the additional (semi-)quantitative perfusion analysis, especially time-intensity curve (TIC) analyses, and wash-in/wash-out kinetics of integrated or external perfusion software programs facilitate new options in dynamic assessment of microvascularization during tumor follow-up care and even minimally invasive tumor therapy.
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Affiliation(s)
- Ernst-Michael Jung
- Institute of Radiology, Interdisciplinary Department for Ultrasound, University Medical Center, Regensburg, Germany. .,Institut für Röntgendiagnostik/Interdisziplinäres Ultraschallzentrum, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Isabel Wiesinger
- Institute of Neuroradiology, Bezirksklinikum Regensburg, Regensburg, Germany
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22
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Guo Y, Song Q, Pan Q. Correlation analysis between rim enhancement features of contrast-enhanced ultrasound and lymph node metastasis in breast cancer. Am J Transl Res 2021; 13:7193-7199. [PMID: 34306481 PMCID: PMC8290713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the correlation between rim enhancement features of contrast-enhanced ultrasound and lymphatic metastasis, and to provide theoretical support for clinical treatment of breast cancer. METHODS 387 breast cancer patients (748 axillary lymph nodes in total) treated in our hospital from January 2017 to January 2020 were selected and analyzed by contrast-enhanced ultrasound. Pathological examination showed that 540 axillary lymph nodes showed metastasis whereas 208 axillary lymph nodes did not show metastasis. Univariate analysis and Logistic stepwise regression were used to analyze the correlation between rim enhancement features of contrast-enhanced ultrasound and axillary lymph node metastasis of breast cancer. RESULTS Peripheral halo, peripheral convergence, rim enhancement, enhancement mode, enhancement amplitude, enhancement sequence, expansion after enhancement, peak intensity, time to peak, area under curve, thrombolysis in myocardial infarction, perfusion sequence, aspect ratio, and maximum cortical thickness were all related to lymph node metastasis of breast cancer by univariate analysis, and the difference was statistically significant (P < 0.05). Multivariate analysis showed that enhancement mode, enhancement amplitude, extension after enhancement, maximum cortical thickness, peak intensity and time to peak were all related to lymph node metastasis of breast cancer. CONCLUSION Rim enhancement features of contrast-enhanced ultrasound of breast cancer are related to lymph node metastasis, which will provide a guidance for clinical treatment of breast cancer.
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Affiliation(s)
- Yanling Guo
- Department of Ultrasound Medicine, Heping Hospital Affiliated to Changzhi Medical College Changzhi, Shanxi, China
| | - Qingfei Song
- Department of Ultrasound Medicine, Heping Hospital Affiliated to Changzhi Medical College Changzhi, Shanxi, China
| | - Qiaohong Pan
- Department of Ultrasound Medicine, Heping Hospital Affiliated to Changzhi Medical College Changzhi, Shanxi, China
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23
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Lin S, Cao Y, Chen L, Chen M, Zhang S, Jia X. Contrast-enhanced ultrasound of breast fibromatosis: a case report. J Int Med Res 2021; 49:3000605211010619. [PMID: 33978517 PMCID: PMC8120548 DOI: 10.1177/03000605211010619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We herein present a rare case of breast fibromatosis, the contrast-enhanced ultrasonography (CEUS) findings of which we believe have never been described. The high similarity between the clinical and imaging manifestations of breast cancer makes its differential diagnosis difficult. In this report, we describe the CEUS findings of a less common type of fibromatosis, discuss the potential value of CEUS to differentiate it from malignant breast lesions, and briefly review the literature.
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Affiliation(s)
- Shanhong Lin
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Yong Cao
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Libin Chen
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Mei Chen
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Shengmin Zhang
- Department of Ultrasound, Ningbo First Hospital, Ningbo, China
| | - Xiupeng Jia
- Ningbo Clinical Pathological Diagnosis Center, Ningbo, China
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Zhang F, Jin L, Li G, Jia C, Shi Q, Du L, Wu R. The role of contrast-enhanced ultrasound in the diagnosis of malignant non-mass breast lesions and exploration of diagnostic criteria. Br J Radiol 2021; 94:20200880. [PMID: 33560894 DOI: 10.1259/bjr.20200880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To assess the value of contrast-enhanced ultrasound (CEUS) for diagnosing malignant non-mass breast lesions (NMLs) and to explore the CEUS diagnostic criteria. METHODS A total of 116 patients with 119 NMLs detected by conventional US were enrolled. Histopathological results were used as the reference standard. The enhancement characteristics of NMLs in CEUS were compared between malignant and benign NMLs. The CEUS diagnostic criteria for malignant NMLs were established using independent diagnostic indicators identified by binary logistic regression analysis. The diagnostic performance of Breast Imaging Reporting and Data System-US (BI-RADS-US), CEUS, and BI-RADS-US combined with CEUS was evaluated and compared. RESULTS Histopathological results showed 63 and 56 benign and malignant NMLs. Enhancement degree (OR = 5.75, p = 0.003), enhancement area (OR = 4.25, p = 0.005), and radial or penetrating vessels (OR = 7.54, p = 0.003) were independent diagnostic indicators included to establish the CEUS diagnostic criteria. The sensitivity and specificity of BI-RADS-US, CEUS, and BI-RADS-US combined with CEUS were 100 and 30.2%, 80.4 and 74.6%, and 94.6 and 77.8%, respectively; the corresponding areas under the receiver operating characteristic curve (AUC) were 0.819, 0.775, and 0.885, respectively. CONCLUSIONS CEUS has a high specificity in malignant NML diagnosis based on the diagnostic criteria including enhancement degree, enhancement area, and radial or penetrating vessels, but with lower sensitivity than BI-RADS-US. The combination of CEUS and BI-RADS-US is an effective diagnostic tool with both high sensitivity and specificity for the diagnosis of malignant NMLs. ADVANCES IN KNOWLEDGE In this study, we assessed the diagnostic value of CEUS for malignant NMLs and constructed a feasible diagnostic criterion. We further revealed that the combination of CEUS and BI-RADS-US has a high diagnostic value for malignant NMLs.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lifang Jin
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Zhou P, Jin C, Lu J, Xu L, Zhu X, Lian Q, Gong X. Modified Model for Diagnosing Breast Imaging Reporting and Data System Category 3 to 5 Breast Lesions: Retrospective Analysis and Nomogram Development. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:151-161. [PMID: 32681744 DOI: 10.1002/jum.15385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/24/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to explore a modified model to simplify the diagnostic process for American College of Radiology Breast Imaging Reporting and Data System category 3 to 5 breast lesions and evaluate the model's diagnostic efficacy. METHODS A retrospective review was conducted of breast lesions examined by B-mode ultrasound (US) and contrast-enhanced ultrasound (CEUS) and diagnosed by histopathologic examination from October 2016 to August 2019. The US characteristics of a combined model (US + CEUS model) with relatively high diagnostic value were selected by a lasso regression analysis to establish a modified model. Two nomograms were developed. The results were internally validated by bootstrap resampling. RESULTS Overall, 206 breast lesions in 198 patients, 136 benign and 70 malignant, were included. Ultrasound characteristics included in the modified model were shape, margin, microcalcification, enhanced intensity, enhanced scope, and enhanced time. For the US + CEUS model and modified model, sensitivities were 94.3% and 93.3%; specificities were 85.9% and 81.4%; accuracies were 89.3% and 88.7% and areas under the curve were 0.957 and 0.944, respectively. No statistically significant differences were seen in the diagnostic efficacies of the models (P = .097). Bootstrap-corrected sensitivities, specificities. and accuracies of the models were consistent with these results. Bootstrap-corrected areas under the curve for the US + CEUS model and the modified model were 0.955 and 0.940, respectively. CONCLUSIONS The modified model with fewer indicators conveniently and effectively diagnosed the malignancy of Breast Imaging Reporting and Data System category 3 to 5 breast lesions without reducing diagnostic efficacy.
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Affiliation(s)
- Peng Zhou
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianghao Lu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lifeng Xu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiaomin Zhu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qingshu Lian
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xuehao Gong
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
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Janu E, Krikavova L, Little J, Dvorak K, Brancikova D, Jandakova E, Pavlik T, Kovalcikova P, Kazda T, Valek V. Prospective evaluation of contrast-enhanced ultrasound of breast BI-RADS 3-5 lesions. BMC Med Imaging 2020; 20:66. [PMID: 32552678 PMCID: PMC7302394 DOI: 10.1186/s12880-020-00467-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the benefit of contrast-enhanced ultrasound (CEUS) in the assessment of breast lesions. METHODS A standardized contrast-enhanced ultrasound was performed in 230 breast lesions classified as BI-RADS category 3 to 5. All lesions were subjected to qualitative and quantitative analysis. MVI (MicroVascular Imaging) technique was used to derive qualitative analysis parameters; blood perfusion of the lesions was assessed (perfusion homogeneity, type of vascularization, enhancement degree). Quantitative analysis was conducted to estimate perfusion changes in the lesions within drawn regions of interest (ROI); parameters TTP (time to peak), PI (peak intensity), WIS (wash in slope), AUC (area under curve) were obtained from time intensity (TI) curves. Acquired data were statistically analyzed to assess the ability of each parameter to differentiate between malignant and benign lesions. The combination of parameters was also evaluated for the possibility of increasing the overall diagnostic accuracy. Biological nature of the lesions was verified by a pathologist. Benign lesions without histopathological verification (BI-RADS 3) were followed up for at least 24 months. RESULTS Out of 230 lesions, 146 (64%) were benign, 67 (29%) were malignant, 17 (7%) lesions were eliminated. Malignant tumors showed statistically significantly lower TTP parameters (sensitivity 77.6%, specificity 52.7%) and higher WIS values (sensitivity 74.6%, specificity 66.4%) than benign tumors. Enhancement degree also proved to be statistically well discriminating as 55.2% of malignant lesions had a rich vascularity (sensitivity 89.6% and specificity 48.6%). The combination of quantitative analysis parameters (TTP, WIS) with enhancement degree did not result in higher accuracy in distinguishing between malignant and benign breast lesions. CONCLUSIONS We have demonstrated that contrast-enhanced breast ultrasound has the potential to distinguish between malignant and benign lesions. In particular, this method could help to differentiate lesions BI-RADS category 3 and 4 and thus reduce the number of core-cut biopsies performed in benign lesions. Qualitative analysis, despite its subjective element, appeared to be more beneficial. A combination of quantitative and qualitative analysis did not increase the predictive capability of CEUS.
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Affiliation(s)
- Eva Janu
- The Clinic of Radiology and Nuclear Medicine, The University Hospital Brno, Brno, Czech Republic.,The Clinic of Radiology and Nuclear Medicine, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucie Krikavova
- The Clinic of Radiology and Nuclear Medicine, The University Hospital Brno, Brno, Czech Republic
| | - Jirina Little
- The Clinic of Radiology and Nuclear Medicine, The University Hospital Brno, Brno, Czech Republic
| | - Karel Dvorak
- The Clinic of Radiology and Nuclear Medicine, The University Hospital Brno, Brno, Czech Republic
| | - Dagmar Brancikova
- The Clinic of Internal Medicine - Haematology and Oncology, The University Hospital Brno, Brno, Czech Republic
| | - Eva Jandakova
- The Institute of Pathology, The University Hospital Brno, Brno, Czech Republic
| | - Tomas Pavlik
- The Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Petra Kovalcikova
- The Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Zluty kopec 7, 65653, Brno, Czech Republic. .,Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Vlastimil Valek
- The Clinic of Radiology and Nuclear Medicine, The University Hospital Brno, Brno, Czech Republic
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Update on Breast Density, Risk Estimation, and Supplemental Screening. AJR Am J Roentgenol 2020; 214:296-305. [DOI: 10.2214/ajr.19.21994] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Advanced approaches to imaging primary breast cancer: an update. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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