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Significance of microvascular evaluation of ductal lesions on breast ultrasonography: Influence on diagnostic performance. Clin Imaging 2018; 51:252-259. [PMID: 29902659 DOI: 10.1016/j.clinimag.2018.05.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/10/2018] [Accepted: 05/31/2018] [Indexed: 11/21/2022]
Abstract
We aim to investigate the significance of microvascular ultrasonography in breast ductal lesions for distinguishing benign from malignant lesions. Sixty-two ductal lesions were evaluated with gray-scale and three Doppler techniques before biopsy, Superb Microvascular Imaging (SMI), color Doppler (CDI), and power Doppler imaging (PDI). We evaluated number, distribution, and morphology of vessels. The area under the ROC curve of combined use of Doppler imaging was greater than that of gray-scale only and SMI had higher value than CDI and PDI (p < 0.05). Microvascular ultrasonography improves diagnostic performance that distinguishes benign from malignant breast ductal lesions, and SMI is superior to CDI and PDI.
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Park A, Seo B, Woo O, Jung K, Cho K, Park E, Cha S, Cha J. The utility of ultrasound superb microvascular imaging for evaluation of breast tumour vascularity: comparison with colour and power Doppler imaging regarding diagnostic performance. Clin Radiol 2018; 73:304-311. [DOI: 10.1016/j.crad.2017.10.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/25/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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3
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Yongfeng Z, Ping Z, Wengang L, Yang S, Shuangming T. Application of a Novel Microvascular Imaging Technique in Breast Lesion Evaluation. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2097-2105. [PMID: 27321174 DOI: 10.1016/j.ultrasmedbio.2016.05.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/01/2016] [Accepted: 05/09/2016] [Indexed: 06/06/2023]
Abstract
Conventional power Doppler imaging (PDI) and the novel Superb Microvascular Imaging (SMI) technique were applied to observe the distribution of microvessels in 135 breast lesions, using semi-quantitative grading, penetrating vessel evaluation and flow distribution pattern to evaluate diagnostic efficacy. Compared with PDI, SMI detected more flow signals and details of microvessels. Further, when a centrally distributed branching or diffusing mode was used as a criterion for diagnosing malignancy, SMI improved diagnosis of breast masses. Sensitivity, specificity, positive predictive value and negative predictive value of SMI-assessed flow distribution were 85.4%, 92.6%, 83.3% and 93.5%, respectively, compared with 70.7%, 92.6%, 80.5% and 87.9% for PDI. We also found that flow distribution pattern analysis is superior to semi-quantitative grading and the penetrating vessel method in differentiating malignant breast lesions. Our work here further supports SMI as a novel and promising technique in visualizing microvasculature in breast lesions that may be of paramount use in initial diagnosis as well as follow-up assessment in various treatment regimes.
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Affiliation(s)
- Zhao Yongfeng
- Department of Ultrasound, Third Xiangya Hospital of Central South University, Hunan, China
| | - Zhou Ping
- Department of Ultrasound, Third Xiangya Hospital of Central South University, Hunan, China.
| | - Liu Wengang
- Department of Ultrasound, Third Xiangya Hospital of Central South University, Hunan, China
| | - Shao Yang
- Department of Ultrasound, Third Xiangya Hospital of Central South University, Hunan, China
| | - Tian Shuangming
- Department of Ultrasound, Third Xiangya Hospital of Central South University, Hunan, China
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4
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Medeiros LR, Duarte CS, Rosa DD, Edelweiss MI, Edelweiss M, Silva FR, Winnnikow EP, Simões Pires PD, Rosa MI. Accuracy of magnetic resonance in suspicious breast lesions: a systematic quantitative review and meta-analysis. Breast Cancer Res Treat 2011; 126:273-85. [PMID: 21221772 DOI: 10.1007/s10549-010-1326-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 12/20/2010] [Indexed: 12/21/2022]
Abstract
Dynamic contrast-enhanced breast magnetic resonance (MR) is a promising emerging technique for evaluating breast lesions. A quantitative systematic review was performed to estimate the accuracy of breast MR in the diagnosis of high-risk breast lesions and breast cancer. A comprehensive search of the Cochrane Library, MEDLINE, CANCERLIT, LILACS, and EMBASE databases was performed from January 1985 to August 2010. The medical subjects heading (MeSH) and text words for the terms "breast neoplasm", "breast lesions", "breast cancer" and "magnetic resonance" were combined with the MeSH term diagnosis ("sensitivity and specificity"). Studies that compared breast MR with paraffin-embedded sections parameters for the diagnosis of breast lesions (benign, high-risk borderline, and breast cancer) were included. Sixty-nine studies were analyzed, which included 9,298 women with 9,884 breast lesions. Interrater overall agreement between breast MR and paraffin section diagnosis was 79% (κ = 0.55), indicating moderate agreement. Pooled sensitivity and specificity were 90% [95% CI 88-92%] and 75% [95% CI 70-79%], respectively. The pooled likelihood positive ratio was 3.64 (95% CI 3.0-4.2) and the negative ratio was 0.12 (95% CI 0.09-0.15). For breast cancer or high-risk lesions versus benign lesions, the AUC was 0.91 for breast MR and the point Q* was 0.84. In summary, breast MR is a useful pre-operative test for predicting the diagnosis of breast lesions.
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Affiliation(s)
- Lidia Rosi Medeiros
- Postgraduate Program in Medicine, Medical Sciences at Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
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Huang YL, Kuo SJ, Hsu CC, Tseng HS, Hsiao YH, Chen DR. Computer-aided diagnosis for breast tumors by using vascularization of 3-D power Doppler ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:1607-1614. [PMID: 19647918 DOI: 10.1016/j.ultrasmedbio.2009.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 05/12/2009] [Accepted: 05/18/2009] [Indexed: 05/28/2023]
Abstract
This study assessed the accuracy of three-dimensional (3-D) power Doppler ultrasound in differentiating between benign and malignant breast tumors by using a support vector machine (SVM). A 3-D power Doppler ultrasonography was performed on 164 patients with 86 benign and 78 malignant breast tumors. The volume-of-interest (VOI) in 3-D ultrasound images was automatically generated from three rectangular regions-of-interest (ROI). The vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) on 3-D power-Doppler ultrasound images were evaluated for the entire volume area, computer extracted VOI area and the area outside the VOI. Furthermore, patient's age and VOI volume were also applied for breast tumor classifications. Each ultrasonography in this study was classified as benign or malignant based on the features using the SVM model. All the tumors were sampled using k-fold cross-validation (k=10) to evaluate the diagnostic performance with receiver operating characteristic (ROC) curves. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of SVM for classifying malignancies were 94%, 69%, 73%, 92% and 81%, respectively. The classification performance in terms of Az value for the ROC curve of the features derived from 3-D power Doppler is 0.91. This study indicates that combining 3-D power Doppler vascularity with patient's age and tumor size offers a good method for differentiating benign and malignant breast tumors.
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Affiliation(s)
- Yu-Len Huang
- Department of Computer Science and Information Engineering, Tunghai University, Taichung, Taiwan.
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Schmillevitch J, Guimarães Filho HA, De Nicola H, Gorski AC. Utilização do índice de resistência vascular na diferenciação entre nódulos mamários benignos e malignos. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000400010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: O objetivo deste estudo foi avaliar o significado do Doppler espectral por meio da obtenção do índice de resistência vascular na diferenciação entre lesões mamárias benignas e malignas. MATERIAIS E MÉTODOS: Dezenove lesões malignas e 18 benignas, diagnosticadas por estudo histológico, foram submetidas previamente a análise de sua vascularização por meio do Doppler espectral para se obter o índice de resistência vascular. RESULTADOS: Observou-se diferença estatisticamente significante (p < 0,001) entre os valores médios do índice de resistência para os resultados benigno e maligno (0,62x 0,80, respectivamente), em nódulos maiores que 1 cm. Um índice de resistência 0,69 foi altamente associado a lesões malignas, com sensibilidade de 84,2%, especificidade de 88,9%, taxa de falso-positivo de 11,1% e taxa de falso-negativo de 15,8%. CONCLUSÃO: A análise do índice de resistência vascular pode fornecer grande auxílio na avaliação das lesões nodulares da mama maiores que 1 cm, em conjunto com as informações obtidas por meio da escala de cinzas, com elevada sensibilidade e especificidade.
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Kuo SJ, Hsiao YH, Huang YL, Chen DR. Classification of benign and malignant breast tumors using neural networks and three-dimensional power Doppler ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2008; 32:97-102. [PMID: 18521971 DOI: 10.1002/uog.4103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES To evaluate the use of three-dimensional (3D) power Doppler ultrasound in the differential diagnosis of solid breast tumors using a neural network model as a classifier. METHODS Data from 102 benign and 93 malignant breast tumor images that had pathological confirmation were collected consecutively from January 2003 to February 2004. We used 3D power Doppler ultrasound to calculate three indices (vascularization index (VI), flow index (FI) and vascularization flow index (VFI)) for the tumor itself and for the tumor plus a 3-mm shell surrounding it. These data were applied to a multilayer perception (MLP) neural network model and we evaluated the model as a classifier to assess the capability of 3D power Doppler sonography to differentiate between benign and malignant solid breast tumors. RESULTS The accuracy of the MLP model for classifying malignancy was 84.6%, the sensitivity was 90.3%, the specificity was 79.4%, the positive predictive value was 80.0% and the negative predictive value was 90.0%. When the neural network was used to combine the three 3D power Doppler indices, the area under the receiver-operating characteristics curve was 0.89. CONCLUSIONS 3D power Doppler ultrasound may serve as a useful tool in distinguishing between benign and malignant breast tumors, and its capability may be increased by using a MLP neural network model as a classifier.
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Affiliation(s)
- S-J Kuo
- Comprehensive Breast Cancer Center, Surgical Research Laboratory, Changhua Christian Hospital, Changhua, Taiwan
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8
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Role of sonoelastography in non-palpable breast lesions. Eur Radiol 2008; 18:2381-9. [DOI: 10.1007/s00330-008-1032-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 03/07/2008] [Accepted: 03/30/2008] [Indexed: 12/21/2022]
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9
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Hsiao YH, Kuo SJ, Liang WM, Huang YL, Chen DR. Intra-tumor flow index can predict the malignant potential of breast tumor: dependent on age and volume. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:88-95. [PMID: 17720297 DOI: 10.1016/j.ultrasmedbio.2007.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 06/13/2007] [Accepted: 06/21/2007] [Indexed: 05/16/2023]
Abstract
The aim of this study was to assess tumor vascularity through three dimensional (3D) power Doppler breast ultrasound (US) and propose a decision model for the classification of benign and malignant breast tumors. Patient recruitment for this study was performed consecutively during a 13-mo period (January 2003 to February 2004). A total of 102 benign and 93 malignant solid breast images were analyzed. Three-dimensional power Doppler US imaging was performed using a Voluson730 ultrasound system equipped with a relative stopping power index (RSP) 6 to 12 transducer. The Virtual Organ Computer-aided Analysis (VOCAL)-imaging program (version 2.1) was used to analyze the stored volume. Histogram indices of the vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) for the intra-tumor and for shells with a thickness of 3 mm surrounding the breast lesion were calculated and showed that for both, malignancy had a higher VI, FI and VFI than benignancy, with statistical significance. Multivariate and stepwise logistic regression revealed the model (including patient age, volume and intra-tumor FI in 3D power Doppler vascularity) to be the best choice for malignant breast tumor characterization. The receiver operating characteristics (ROC) index for the performance of the model was 0.926. Histogram indices for the intra-tumor FI in the 3D power Doppler scan are a good choice of parameter for differentiating between malignant and benign tumors with respect to the power of sensitivity, no matter whether one index is suggested or the patients' age and volume are considered.
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Affiliation(s)
- Yi-Hsuan Hsiao
- Institute of Medical Research, Chang Jung Christian University, Tainan, Taiwan Department of Medical Education and Research, Division of Clinical Breast Cancer Research and Cancer Biology, Changhua Christian Hospital, Changhua, Taiwan
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10
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Peters NHGM, Borel Rinkes IHM, Zuithoff NPA, Mali WPTM, Moons KGM, Peeters PHM. Meta-analysis of MR imaging in the diagnosis of breast lesions. Radiology 2007; 246:116-24. [PMID: 18024435 DOI: 10.1148/radiol.2461061298] [Citation(s) in RCA: 375] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To determine, in a meta-analysis, the diagnostic performance of contrast material-enhanced magnetic resonance (MR) imaging in patients with breast lesions. MATERIALS AND METHODS Studies to assess the diagnostic performance of MR imaging in patients suspected of having breast cancer who underwent MR imaging and biopsy from January 1985 through March 2005 were reviewed for inclusion. A summary receiver operating characteristic curve was constructed, and pooled weighted estimates of sensitivity and specificity were calculated by using the recently developed bivariate approach for diagnostic meta-analysis. RESULTS Of 251 eligible studies, 44 were included in the meta-analysis (sample size range, 14-821; cancer prevalence, 23%-84%). Pooled weighted estimates of sensitivity and specificity were 0.90 (95% confidence interval: 0.88, 0.92) and 0.72 (95% confidence interval: 0.67, 0.77), respectively. The performance of breast MR imaging was influenced by the prevalence of cancer in the studied population (P = .05) and by whether two criteria (ie, morphology, enhancement, and kinetic enhancement pattern)--versus one or three criteria--were used to differentiate benign from malignant lesions (P = .02). CONCLUSION MR imaging of the breast has high sensitivity and lower specificity in the evaluation of breast lesions. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/2461061298/DC1.
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Affiliation(s)
- Nicky H G M Peters
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132, 3584 CX Utrecht, The Netherlands
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Kotsianos D, Wirth S, Fischer T, Hiltawsky K, Sittek H, Reiser M. 3D-Ultraschall (3D-US) in der Diagnostik von Mammaherdbefunden. Radiologe 2005; 45:237-44. [PMID: 15747149 DOI: 10.1007/s00117-005-1181-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND It was to analyse whether 3D breast US is able to enhance the diagnosis of focal breast lesions. MATERIAL AND METHODS 60 patients were examined with 2D- and 3D US (GE logiq 9, 14 MHz). The solid lesions were analyzed by using the BIRADS classification. As standard of reference, histopathologic results were available in all cases. RESULTS 38 malignant and 22 benign lesions were analyzed. With 2D US the sensitivity/specificity was 92/81%, with 3D US 97/72%, and by combination of 2D and 3D 97/81%. Characteristics of benign solid masses included a round or oval shape as well as clearly defined and sharply demarcated margins. CONCLUSIONS 3D US allows to demonstrate breast masses in multiple planes. Distorsion of the surrounding soft tissues is an important sign indicative of malignancy.
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Affiliation(s)
- D Kotsianos
- Institut für Klinische Radiologie, Klinikum der Universität München.
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12
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Abstract
Ultrasound is an important imaging modality in evaluating the breast. One of the most common uses of ultrasound is to help distinguish benign from malignant breast disease, primarily with gray-scale ultrasound but also with Doppler ultrasound. Another common use is to provide guidance for interventional procedures. Less common uses include assisting in staging of breast cancer and evaluating patients with implants. Recently there has been an interest in using ultrasound to screen asymptomatic women for breast cancer, as is done with mammography. Further studies must be performed to assess if this reduces mortality from breast cancer. Although primarily used to image the female breast, ultrasound also can be used to evaluate breast-related concerns in men. Uses of contrast-enhanced ultrasound are still experimental and would add an invasive component to an otherwise noninvasive study.
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Affiliation(s)
- Tejas S Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA.
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Mehta TS, Raza S, Baum JK. Use of Doppler ultrasound in the evaluation of breast carcinoma. Semin Ultrasound CT MR 2000; 21:297-307. [PMID: 11014252 DOI: 10.1016/s0887-2171(00)90024-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ultrasound is an imaging modality commonly used to evaluate breast lesions in hopes to distinguish benign from malignant solid masses. Angiogenesis, defined as the emergence of new vessels to further the growth of tumor, has stimulated interest in the potential uses of Doppler ultrasound in patients with breast cancer. This article describes different forms of Doppler ultrasound, including color Doppler (CD), power Doppler (PD), and spectral Doppler (SD), as well as 3-dimensional (3D) ultrasound and ultrasound contrast media. We review the role of Doppler ultrasound in distinguishing benign from malignant solid breast masses. We also discuss the role of ultrasound in predicting tumor grade, histology, node status, and lymphatic vascular invasion, and in monitoring breast cancer treatment.
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Affiliation(s)
- T S Mehta
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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14
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Dooley W. Surgery in breast cancer. Curr Opin Oncol 1999; 11:447-62. [PMID: 10550008 DOI: 10.1097/00001622-199911000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This year (1999) has been filled with new information on the prevention of breast cancer and new literature trying to address some of the long-term adverse consequences of our surgical therapies. As the complexities of our therapies continue to increase at exponential rates, we now also have the ability to more accurately predict the consequences of both our therapeutic actions and our failure to act. Nowhere is this more evident than in the literature devoted to long-term consequences of treatment for breast cancer. As we are more successful in achieving our goals of increased survival from this dreaded disease, the future needs of these long-term survivors must play an ever-increasing role in our current management. Advances reported this year are laying down a new basis for efforts to improve the quality of life for breast cancer survivors.
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Affiliation(s)
- W Dooley
- Johns Hopkins Oncology Center, Baltimore, Maryland 21287, USA.
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