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Mehdikhani B, Benam M, Moradkhani A, Roostaee A, Bahman SS, Barmayoon P, Dezyani G, Safarpour Lima Z. Evaluation of diagnostic value of Doppler ultrasound in the diagnosis of malignant breast masses. Eur J Transl Myol 2024; 34:12372. [PMID: 38536011 PMCID: PMC11264213 DOI: 10.4081/ejtm.2024.12372] [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: 02/09/2024] [Accepted: 02/25/2024] [Indexed: 04/19/2024] Open
Abstract
Breast cancer is the leading cause of cancer mortality in women, and it is on the rise in Iran. Therefore, an early-stage diagnosis of breast cancer is of critical importance. Because ultrasound is one of the available, inexpensive, and minimally invasive techniques for distinguishing malignant from benign masses, a comparison of conventional ultrasound, color Doppler, and spectral Doppler findings can be useful. The purpose of this study was to determine the diagnostic value of sonographic indices, specifically Doppler parameters, in identifying the nature of breast masses. This is a cross-sectional study, with diagnostic value analysis. Before undergoing a biopsy, 80 patients with breast masses underwent B-mode and Doppler breast ultrasound. The ultrasound findings were then compared to pathologic results to determine which groups were malignant or benign. The resulting data were analyzed using statistical tests and diagnostic values with SPSS 22 software. B-mode grey-scale ultrasound indices such as mass shape, mass margin, mass orientation, and posterior features, as well as Doppler indices such as vascularity, RI (Resistive Index), PI (Pulsatility Index), and PSV (Peak Systolic Velocity), were found to be statistically significant with pathological findings. Color Doppler revealed vascularity in 65% of benign and 84% of malignant masses. The diagnostic value results revealed that mass shape, mass margin, mass orientation, and posterior features all play a significant role in predicting lesion malignancy, with a sensitivity of 92%, 58%, 64%, 56%, and specificity of 59%, 66%, 82%, and 84%, respectively. The RI, PI, and PSV indices were significantly higher in malignant masses, and all of them had remarkable diagnostic values in predicting malignancy, with a (Area Under The Curve) AUC of 0.863, 0.882, 0.702, a sensitivity of 84% and 84%, 68%, and a specificity of 83%, 86%, and 62%, respectively, at the optimal cut-off points (0.65, 1.32, 12.40) obtained from the Receiver Operating Characteristics (ROC) curves.
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Affiliation(s)
- Bahareh Mehdikhani
- Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran.
| | - Milad Benam
- Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran.
| | | | - Ayda Roostaee
- Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran.
| | - Seyedeh Sabahat Bahman
- Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran.
| | - Pooyan Barmayoon
- Department of Radiology, Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran.
| | - Ghazaleh Dezyani
- Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran.
| | - Zeinab Safarpour Lima
- Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran.
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Luo R, Zhang Y, Jiang W, Wang Y, Luo Y. Value of micro-flow imaging and high-definition micro-flow imaging in differentiating malignant and benign breast lesions. Clin Radiol 2024; 79:e48-e56. [PMID: 37932209 DOI: 10.1016/j.crad.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 09/03/2023] [Accepted: 10/08/2023] [Indexed: 11/08/2023]
Abstract
AIM To evaluate the value of non-contrast micro-flow imaging (MFI) and high-definition micro-flow imaging (HD-MFI) in differentiating malignant and benign breast lesions. MATERIALS AND METHODS One hundred and thirty-three patients with 138 breast lesions (80 benign and 58 malignant lesions) were examined using colour Doppler flow imaging (CDFI), MFI, and HD-MFI before biopsy, with blood flow signals graded into four types (grade 0, 1, 2, and 3) and penetrating vessels evaluated. The micro-vascular patterns of MFI and HD-MFI were evaluated and classified into five patterns: avascular, line-like, tree-like, root hair-like, and crab claw-like pattern. The diagnostic efficiency of micro-vascular patterns was analysed. Moreover, ultrasound Breast Imaging Reporting and Data System (BI-RADS) 4A lesions were also re-assessed according to the micro-vascular patterns of MFI or HD-MFI. RESULTS The capability of detecting blood flow and penetrating vessels from high to low was HD-MFI, MFI, and CDFI, respectively (p<0.05). Rich blood flow signals, penetrating vessels, and root hair-like or crab claw-like pattern were more likely in malignant breast lesions, while few blood flow signals, tree-like pattern were mostly in benign lesions (p<0.05). The diagnostic efficiency of HD-MFI and MFI were higher than CDFI (p>0.05). MFI could reduce unnecessary biopsy of 52 US BI-RADS 4A lesions but with two malignancies missed, while 56 ultrasound BI-RADS 4A lesions could be downgraded by HD-MFI with none malignancies missed. CONCLUSIONS MFI and HD-MFI can detect more blood flow in breast lesions than CDFI, and could help distinguish benign and malignant breast lesions. HD-MFI could reduce the unnecessary biopsy of US BI-RADS 4A lesions without missed malignancy.
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Affiliation(s)
- R Luo
- Medical College, Yangzhou University, Yangzhou, Jiangsu, China; Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y Zhang
- Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - W Jiang
- Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y Wang
- Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Y Luo
- Department of Ultrasound, Division of First Medical Center, Chinese PLA General Hospital, Beijing, China.
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Mohindra N, Jain N, Yadav S, Agrawal V, Mishra P, Mishra A, Agarwal G. Utility of ultrasound Angio-PLUS imaging for detecting blood flow in breast masses and comparison with color Doppler for differentiating benign from malignant masses. Acta Radiol 2023; 64:2087-2095. [PMID: 36890701 DOI: 10.1177/02841851231160076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
BACKGROUND Tumor neo-angiogenesis plays an important role in the development and growth of breast cancers, but its detection by imaging is challenging. A novel microvascular imaging (MVI) technique, Angio-PLUS, promises to overcome the limitations of color Doppler (CD) in detecting low-velocity flow and small diameter vessels. PURPOSE To determine the utility of the Angio-PLUS technique for detecting blood flow in breast masses and compare it with CD for differentiating benign from malignant masses. MATERIAL AND METHODS A total of 79 consecutive women with breast masses were prospectively evaluated using CD and Angio-PLUS techniques, and biopsied as per BI-RADS recommendations. Vascular imaging scores were assigned using three factors (number, morphology, and distribution) and vascular patterns were divided into five groups: internal-dot-spot, external-dot-spot, marginal, radial, and mesh patterns. The independent samples t-test, Mann-Whitney U test, Wilcoxon signed rank test, or Fisher's exact test were used to compare the two groups as appropriate. Area under the receiver operating characteristic (ROC) curve (AUC) methods were used to assess diagnostic accuracy. RESULTS Vascular scores were significantly higher on Angio-PLUS than CD (median=11, [IQR=9-13] vs. 5 [IQR=3-9], P < 0.001). Malignant masses had higher vascular scores than benign masses on Angio-PLUS (P < 0.001). AUC was 80% (95% CI=70.3-89.7; P < 0.001) for Angio-PLUS and 51.9% for CD. Using Angio-PLUS at a cutoff value of ≥9.5, sensitivity was 80% and specificity was 66.7%. Vascular pattern descriptors on AP showed good correlation with histopathological results (PPV mesh 95.5%, radial 96.9%, and NPV of marginal orientation 90.5%). CONCLUSION Angio-PLUS was more sensitive in detecting vascularity and superior in differentiating benign from malignant masses compared to CD. Vascular pattern descriptors on Angio-PLUS were useful.
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Affiliation(s)
- Namita Mohindra
- Department of Radio-diagnosis, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Neeraj Jain
- Department of Radio-diagnosis, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Shubham Yadav
- Department of Radio-diagnosis, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Vinita Agrawal
- Department of Pathology, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Prabhakar Mishra
- Department of Biostatistics, 30093Sanjay Gandhi Post-graduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Anjali Mishra
- Department of Endocrine and Breast Surgery, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
| | - Gaurav Agarwal
- Department of Endocrine and Breast Surgery, 30093Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India
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Watanabe T, Yamaguchi T, Okuno T, Konno S, Takaki R, Sato M, Tsuruoka M, Shirai H, Ogawa Y, Ban K, Fujimoto Y, Hirokaga K, Watanabe R, Morita T. Utility of B-Mode, Color Doppler and Elastography in the Diagnosis of Breast Cancer: Results of the CD-CONFIRM Multicenter Study of 1351 Breast Solid Masses. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3111-3121. [PMID: 34456085 DOI: 10.1016/j.ultrasmedbio.2021.07.009] [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: 09/21/2020] [Revised: 06/06/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
The usefulness of color Doppler ultrasound (CD) in distinguishing between benign and malignant breast lesions remains controversial. Our prior study, the Japan Association of Breast and Thyroid Sonology (JABTS) BC-04 study (malignant: 839, benign: 569), found CD was useful in breast cancer diagnosis, and we developed CD diagnostic criteria. The first aim of the current study (the CD-CONFIRM study) was to evaluate the usefulness of the CD diagnostic criteria. The second aim was to evaluate the relationship between CD and elastography. We evaluated ultrasound images of breast masses from 13 institutions (malignant: 639, benign: 712). While the sensitivity of B-mode alone was very high and was not significantly improved with CD, the specificity was significantly improved with CD (61.2%-69.2%, p < 0.0001). Furthermore, the specificity of the combination of B-mode and CD improved significantly with the addition of elastography (72.8%-79.0%, p < 0.0001). This study found that the CD criteria are useful, and CD and elastography are independent.
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Affiliation(s)
- Takanori Watanabe
- Department of Breast Surgery, National Hospital Organization Sendai Medical Center, Sendai City, Miyagi, Japan.
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Toshitaka Okuno
- Breast Surgery, Kobe City Nishi-Kobe Medical Center, Kobe City, Hyogo, Japan
| | - Sachiyo Konno
- Center of Medical Ultrasonics, Dokkyo Medical University Hospital, Mibu City, Tochigi, Japan
| | - Rie Takaki
- Clinical Laboratory Examination Department, Sagara Hospital, Kagoshima City, Kagoshima, Japan
| | - Megumi Sato
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo City, Hokkaido, Japan
| | - Masahiko Tsuruoka
- Department of Radiology, Moriya Keiyu Hospital, Tatsuzawa Moriya City, Ibaraki, Japan
| | - Hideaki Shirai
- Department of Clinical Laboratory, Sapporo Kotoni Breast Clinic, 2Nishi-ku, Sapporo City, Hokkaido, Japan
| | - Yukari Ogawa
- Division of Ultrasonographic Examination, Kameda Medical Center, Kamogawa City, Chiba, Japan
| | - Kanako Ban
- Department of Cancer Detection and Diagnosis, Tokyo Health Service Association, Shinjuku-ku, Tokyo, Japan
| | | | - Koichi Hirokaga
- Department of Breast Surgery, Hyogo Cancer Center, Akashi City, Hyogo, Japan
| | - Ryoji Watanabe
- Department of Breast Center, Itoshima Medical Association Hospital, Itoshima City, Fukuoka, Japan
| | - Takako Morita
- Department of Breast Surgery, National Hospital Organization Nagoya Medical Center, Nagoya City, Aichi, Japan
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Chae EY, Yoon GY, Cha JH, Shin HJ, Choi WJ, Kim HH. Added Value of the Vascular Index on Superb Microvascular Imaging for the Evaluation of Breast Masses: Comparison With Grayscale Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:715-723. [PMID: 32815564 DOI: 10.1002/jum.15441] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the value of the vascular index (VI) on Superb Microvascular Imaging (SMI; Canon Medical Systems Corporation, Tokyo, Japan) in comparison with grayscale ultrasound (US) alone for assessing breast masses. METHODS We evaluated a total of 70 breast masses (36 malignant and 34 benign lesions) in 70 consecutive patients using grayscale US and SMI. Two breast radiologists analyzed grayscale US alone and the combination of grayscale US and SMI. They also measured the VI based on SMI. The diagnostic performance of grayscale US alone and the combination of grayscale US and SMI was compared. The VI was compared between benign and malignant masses, and the optimal cutoff value was determined. In addition, the interobserver agreement in imaging analyses and the VI was assessed. RESULTS The interobserver agreements in imaging analyses and the VI were almost perfect. The VI of malignant breast masses was significantly higher than that of benign lesions (P < .001). The optimal cutoff value of the VI for differentiating between malignant and benign breast masses was 2.95, with sensitivity of 86.1% and specificity of 91.2%. The diagnostic performance values of grayscale US alone and the combination of grayscale US and SMI were 0.824 and 0.912, respectively, for reader 1 (P = .028) and 0.795 and 0.853 for reader 2 (P = .101). CONCLUSIONS The VI on SMI was significantly higher for malignant breast masses than for benign lesions, with high interobserver agreement. Our study suggests that the combination of grayscale US and SMI with the VI could improve the characterization of breast masses.
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Affiliation(s)
- Eun Young Chae
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ga Young Yoon
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joo Hee Cha
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jung Shin
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Jung Choi
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hak Hee Kim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Li W, Zhou Q, Xia S, Wu Y, Fei X, Wang Y, Tao L, Fan J, Zhou W. Application of Contrast-Enhanced Ultrasound in the Diagnosis of Ductal Carcinoma In Situ: Analysis of 127 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:39-50. [PMID: 31206200 DOI: 10.1002/jum.15069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To explore the characteristics of breast ductal carcinoma in situ (DCIS) on real-time grayscale contrast-enhanced ultrasound (CEUS) imaging and the diagnostic value of CEUS in DCIS. METHODS A total of 127 histopathologically confirmed DCIS lesions and 124 fibroadenomas (FAs; controls) were subjected to conventional ultrasound and CEUS. Next, the CEUS findings of DCIS and FA lesions, including morphologic features and quantitative parameters, were analyzed. RESULTS Binary logistic regression was used to identify the independent risk factors from DCIS and FA lesions detected by CEUS. Contrast-enhanced ultrasound revealed significant differences between DCIS and FA. The wash-in time, enhancement mode, enhancement intensity, blood perfusion defects, peripheral high enhancement, enhancement scope, intratumoral vessels and their courses and dilatation degree, and penetrating vessels on CEUS were identified as features correlated with DCIS (P < .05). Moreover, a multivariate logistic regression analysis was developed, and the area under receiver operating characteristic curve of each index was generated, including the wash-in time, enhancement intensity, blood perfusion defects, enhancement scope, penetrating vessels, arrival time, and peak intensity (P < .05; area under the curve, >0.6). CONCLUSIONS The contrast-enhancement patterns and DCIS parameters appeared different from FA lesions, thus suggesting that CEUS can be very useful in distinguishing DCIS from FA lesions.
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Affiliation(s)
- Weiwei Li
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qinghua Zhou
- Departments of Breast Surgery, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shujun Xia
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wu
- Departments of Breast Surgery, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaochun Fei
- Departments of Pathology (X.F.), Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Wang
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lingling Tao
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinfang Fan
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhou
- Departments of Diagnostic Ultrasound, Luwan Branch, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Vilagran M, Del Riego J, Palaña P, Sentís M, Planas J, Oliva JC, Gómez V. Parallel vessels as a predictor of benignity in solid breast masses. Breast J 2019; 25:257-261. [PMID: 30727027 DOI: 10.1111/tbj.13190] [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: 09/25/2017] [Accepted: 04/10/2018] [Indexed: 12/01/2022]
Abstract
To evaluate the presence of a parallel artery and vein on color Doppler ultrasound as a predictor of benignity in solid breast masses. This prospective study included all patients with solid breast masses identified by ultrasound at our center from January 2012 through December 2015. All masses were studied with B mode and color Doppler ultrasound. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value, and their respective 95% confidence intervals for the parallel vessel sign against the histologic findings or 2 years' follow-up without changes. A total of 526 solid masses were included in the 3-year period; the parallel vessel sign was observed in 377 (71.6%). We found 74.8% (95% CI: 70.9-78.7) sensitivity, 65% (95% CI: 50.2-79.7) specificity, 96.2% (95% CI: 94.3-98.1) positive predictive value, and 17.5% (95% CI: 11.4-23.6) negative predictive value. Of the 379 masses classified as breast imaging reporting and data system (BI-RADS) 3, the parallel vessel sign was observed in 275 (72.5%); all of these were definitively benign. Of the 109 masses classified as BI-RADS 4, the parallel vessel sign was observed in 89 (80.7%); 88 (98.8%) of these were definitively benign. Of the 38 masses classified as BI-RADS 5, the parallel vessel sign was observed in 13 (34.2%); all of these were definitively malignant. The parallel artery and vein sign is a good predictor of benignity, although it must be analyzed together with other morphologic descriptors.
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Affiliation(s)
- Mariona Vilagran
- Women´s Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Ivestigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain.,Breast Imaging Area, Radiology Department, Hospital General de Granollers, Hospital Universitari, Fundació Privada Hospital Asil de Granollers, Granollers, Spain
| | - Javier Del Riego
- Women´s Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Ivestigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Pau Palaña
- Women´s Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Ivestigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Melcior Sentís
- Women´s Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Ivestigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Jaume Planas
- Breast Imaging Area, Radiology Department, Hospital General de Granollers, Hospital Universitari, Fundació Privada Hospital Asil de Granollers, Granollers, Spain
| | - Joan Carles Oliva
- Epidemiology Department, Fundació Parc-Taulí-Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Virtudes Gómez
- Women´s Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Institut d'Ivestigació i Innovació Parc Tauli I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
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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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Diagnostic Performance of Automated Breast Volume Scanning (ABVS) Compared to Handheld Ultrasonography With Breast MRI as the Gold Standard. Acad Radiol 2017; 24:954-961. [PMID: 28336007 DOI: 10.1016/j.acra.2017.01.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/22/2017] [Accepted: 01/30/2017] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to compare the diagnostic value of automated breast volume scanning (ABVS) to that of handheld ultrasonography (HHUS) using breast magnetic resonance imaging (MRI) as the gold standard. MATERIALS AND METHODS Twenty-eight patients with 39 examined breasts with at least one lesion visible in breast MRI underwent HHUS and ABVS. Detection rate, localization, maximum diameter, and Breast Imaging Reporting and Data System classification were compared. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value were calculated for HHUS and ABVS. Lesion localization and maximum diameters based on HHUS and ABVS were compared to size measurement in MRI. Breast Imaging Reporting and Data System categories based on each method were compared to the MRI diagnosis (malignant or benign) or, if available (21 cases), with the histologic diagnosis. RESULTS MRI detected 72 lesions, ABVS 59 lesions, and HHUS 54 lesions. Malignancy was proven histopathologically in 15 cases. There was no significant difference between ABVS and HHUS in terms of sensitivity (93.3% vs. 100%), specificity (83.3% vs. 83.3%), diagnostic accuracy (87.2% vs. 89.7%), positive predictive value (77.8% vs. 78.9%), and negative predictive value (95.2% vs. 100%). Agreement regarding lesion localization (same quadrant) was 94.3% for ABVS and MRI and 91.2% for HHUS and MRI. Lesion size compared to MRI lesion size was assessed correctly (+/- 3 mm) in 79.4% (HHUS) and 80% (ABVS). The correlation of size measurement was slightly higher for ABVS-MRI (r = 0.89) than for HHUS-MRI (r = 0.82) with P < .001. CONCLUSIONS ABVS can be used as an alternative to HHUS. ABVS has the advantage of operator independence and better reproducibility although it is limited in evaluating axillary lymph nodes and lacks Doppler or elastrography capabilities, which sometimes provide important supplementary information in HHUS.
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Xiao XY, Chen X, Guan XF, Wu H, Qin W, Luo BM. Superb microvascular imaging in diagnosis of breast lesions: a comparative study with contrast-enhanced ultrasonographic microvascular imaging. Br J Radiol 2016; 89:20160546. [PMID: 27529640 DOI: 10.1259/bjr.20160546] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of superb microvascular imaging (SMI) in breast lesions, comparing with contrast-enhanced ultrasonographic microvascular imaging (MVI). METHODS From April to November 2015, 132 patients (with 132 breast lesions) were enrolled in the retrospective study. All lesions were evaluated with colour Doppler flow imaging (CDFI), colour SMI (cSMI), monochrome SMI (mSMI) and contrast-enhanced ultrasonographic MVI. Receiver-operating characteristic curve analysis was performed to compare the diagnostic performance of SMI and MVI for discrimination between benign and malignant breast lesions. RESULTS Histological analysis showed 58 malignant and 74 benign lesions. mSMI was more sensitive in detecting blood flow signals in breast lesions than CDFI (p < 0.001) and cSMI (p < 0.001). Differences of vessels inside breast lesions and morphologic features of vessels between benign and malignant lesions were statistically significant on mSMI (p < 0.001). Using root hair-like and crab claw-like patterns as the criteria for malignant lesions, the sensitivity, specificity and accuracy for differentiation based on the microvascular architecture patterns were 77.6, 90.5 and 84.8% for mSMI and 89.6, 87.8 and 88.6% for MVI. Areas under curve of mSMI and MVI were not significantly different (p = 0.129). CONCLUSION mSMI can increase blood flow detection and depict the microvascular architecture of breast lesions. The diagnostic performance of mSMI was not significantly different from MVI. SMI has potential in the differential diagnosis of breast lesions. ADVANCES IN KNOWLEDGE mSMI is a non-invasive technique for vascularity evaluation of breast tumours and it is beneficial for breast tumour differentiation.
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Affiliation(s)
- Xiao-Yun Xiao
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Chen
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Feng Guan
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huan Wu
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Qin
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bao-Ming Luo
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Exploration d’un syndrome kystique mammaire : recommandations. ACTA ACUST UNITED AC 2015; 44:970-9. [DOI: 10.1016/j.jgyn.2015.09.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/21/2022]
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Liu D, Huang Y, Tian D, Yin J, Deng LJ. Value of sonographic bidirectional arterial flow combined with elastography for diagnosis of breast imaging reporting and data system category 4 breast masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:759-766. [PMID: 25911707 DOI: 10.7863/ultra.35.5.759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the role of bidirectional arterial flow combined with ultrasound elastography for differentiation of American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) category 4 masses. METHODS A total of 116 BI-RADS category 4 breast masses were evaluated with color Doppler sonography, spectral analysis, and elastography. The sensitivity, specificity, accuracy, positive and negative predictive values, and receiver operator characteristic curve were used to estimate the diagnostic performance for each modality and the combination method. RESULTS The combination method had the best sensitivity (81.1%) but less specificity (94.9%) and the best accuracy (90.5%). The discriminating power of the combined method (area under the curve [AUC], 0.880; 95% confidence interval [CI], 80.0%-96.0%) was significantly higher than that of bidirectional arterial flow (AUC, 0.818; 95% CI, 72.0%-91.6%; P< .01) and elastography (AUC, 0.765; 95% CI, 65.9%-87.0%; P< .01). CONCLUSIONS Bidirectional arterial flow evaluation, when combined with elastography, could potentially improve diagnostic accuracy for BI-RADS category 4 breast masses.
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Affiliation(s)
- Da Liu
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Huang
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
| | - Dan Tian
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Yin
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
| | - Li-Jun Deng
- Departments of Orthopedic Surgery (D.L.) and Ultrasound (Y.H., D.T., J.Y., L.D.), Shengjing Hospital of China Medical University, Shenyang, China
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Stanzani D, Chala LF, Barros ND, Cerri GG, Chammas MC. Can Doppler or contrast-enhanced ultrasound analysis add diagnostically important information about the nature of breast lesions? Clinics (Sao Paulo) 2014; 69:87-92. [PMID: 24519198 PMCID: PMC3912319 DOI: 10.6061/clinics/2014(02)03] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/23/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Despite evidence suggesting that Doppler ultrasonography can help to differentiate between benign and malignant breast lesions, it is rarely applied in clinical practice. The aim of this study was to determine whether certain vascular features of breast masses observed by duplex Doppler and color Doppler ultrasonography (before and/or after microbubble contrast injection) add information to the gray-scale analysis and support the Breast Imaging-Reporting and Data System (BI-RADS) classification. METHODS Seventy solid lesions were prospectively evaluated with gray-scale ultrasonography, color Doppler ultrasonography, and contrast-enhanced ultrasonography. The morphological analysis and lesion vascularity were correlated with the histological results. RESULTS Percutaneous core biopsies revealed that 25/70 (17.5%) lesions were malignant, while 45 were benign. Hypervascular lesions with tortuous and central vessels, a resistive index (RI)≥ 0.73 before contrast injection, and an RI≥ 0.75 after contrast injection were significantly predictive of malignancy (p<0.001). CONCLUSION The combination of gray-scale ultrasonography data with unenhanced or enhanced duplex Doppler and color Doppler US data can provide diagnostically useful information. These techniques can be easily implemented because Doppler devices are already present in most health centers.
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Affiliation(s)
- Daniela Stanzani
- Instituto de Radiologia do Hospital das Clínicas da, Faculdade de Medicina da, Universidade de São Paulo, São PauloSP, Brazil, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Luciano F Chala
- Instituto de Radiologia do Hospital das Clínicas da, Faculdade de Medicina da, Universidade de São Paulo, São PauloSP, Brazil, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Nestor de Barros
- Instituto de Radiologia do Hospital das Clínicas da, Faculdade de Medicina da, Universidade de São Paulo, São PauloSP, Brazil, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Giovanni G Cerri
- Instituto de Radiologia do Hospital das Clínicas da, Faculdade de Medicina da, Universidade de São Paulo, São PauloSP, Brazil, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
| | - Maria Cristina Chammas
- Instituto de Radiologia do Hospital das Clínicas da, Faculdade de Medicina da, Universidade de São Paulo, São PauloSP, Brazil, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP, Brazil
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Chen L, Chen Y, Diao XH, Fang L, Pang Y, Cheng AQ, Li WP, Wang Y. Comparative study of automated breast 3-D ultrasound and handheld B-mode ultrasound for differentiation of benign and malignant breast masses. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1735-1742. [PMID: 23849390 DOI: 10.1016/j.ultrasmedbio.2013.04.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/28/2013] [Accepted: 04/04/2013] [Indexed: 06/02/2023]
Abstract
The automated breast volume scanner (ABVS) represents a new technology for diagnosing breast masses. In this study, a total of 219 breast masses in 175 patients underwent both conventional handheld B-mode ultrasound (HHUS) and ABVS examinations, and the differences in the diagnostic values of the two modalities for benign and malignant breast masses were compared with the final pathologic findings. In addition, the diagnostic accuracy for breast masses with features including retraction phenomenon and hyperechoic rim in the coronal plane of the ABVS was evaluated. There were no differences between the ABVS and HHUS in terms of sensitivity (92.5% vs. 88.0%), specificity (86.2% vs. 87.5%), accuracy (88.1% vs. 87.2%), false-positive rate (13.8% vs. 12.5%), false-negative rate (11.8% vs. 7.5%), positive predictive value (74.7% vs. 75.6%) and negative predictive value (96.3% vs. 94.3%) (p > 0.05 for all). However, there were significant differences between the malignant and benign masses with respect to retraction phenomenon and hyperechoic rim in the coronal plane of the ABVS. For retraction phenomenon, both the specificity and positive predictive value of a malignant diagnosis reached 100%, and the accuracy and false-positive rate were 96.8% and 0, respectively; for the hyperechoic rim, the specificity, negative predictive value and accuracy of a benign diagnosis were 92.8%, 95.3% and 95.9%, respectively. Overall, ABVS is a promising modality for the clinical diagnosis of breast masses with retraction phenomenon and hyperechoic rim in the coronal plane, although the ABVS and HHUS do not differ in diagnostic accuracy for the differentiation of malignant or benign breast masses.
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Affiliation(s)
- Lin Chen
- Department of Ultrasound, HuaShan Hospital, Fudan University, Shanghai, China
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Gokalp G, Topal U, Kizilkaya E. Power Doppler sonography: Anything to add to BI-RADS US in solid breast masses? Eur J Radiol 2009; 70:77-85. [DOI: 10.1016/j.ejrad.2007.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 09/21/2007] [Accepted: 12/12/2007] [Indexed: 11/28/2022]
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Athanasiou A, Tardivon A, Ollivier L, Thibault F, El Khoury C, Neuenschwander S. How to optimize breast ultrasound. Eur J Radiol 2009; 69:6-13. [DOI: 10.1016/j.ejrad.2008.07.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Accepted: 07/28/2008] [Indexed: 12/21/2022]
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LeCarpentier GL, Roubidoux MA, Fowlkes JB, Krücker JF, Hunt KA, Paramagul C, Johnson TD, Thorson NJ, Engle KD, Carson PL. Suspicious breast lesions: assessment of 3D Doppler US indexes for classification in a test population and fourfold cross-validation scheme. Radiology 2008; 249:463-70. [PMID: 18936310 DOI: 10.1148/radiol.2492060888] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the diagnostic performance of various Doppler ultrasonographic (US) vascularity measures in conjunction with grayscale (GS) criteria in differentiating benign from malignant breast masses, by using histologic findings as the reference standard. MATERIALS AND METHODS Institutional Review Board and HIPAA standards were followed. Seventy-eight women (average age, 49 years; range, 26-70 years) scheduled for breast biopsy were included. Thirty-eight patient scans were partially analyzed and published previously, and 40 additional scans were used as a test set to evaluate previously determined classification indexes. In each patient, a series of color Doppler images was acquired and reconstructed into a volume encompassing a suspicious mass, identified by a radiologist-defined ellipsoid, in which six Doppler vascularity measures were calculated. Radiologist GS ratings and patient age were also recorded. Multivariable discrimination indexes derived from the learning set were applied blindly to the test set. Overall performance was also confirmed by using a fourfold cross-validation scheme on the entire population. RESULTS By using all cases (46 benign, 32 malignant), the area under the receiver operating characteristic curve (A(z)) values confirmed results of previous analyses: Speed-weighted pixel density (SWPD) performed the best as a diagnostic index, although statistical significance (P = .01) was demonstrated only with respect to the normalized power-weighted pixel density. In both learning and test sets, the three-variable index (SWPD-age-GS) displayed significantly better diagnostic performance (A(z) = 0.97) than did any single index or the one two-variable index (age-GS) that could be obtained without the data from the Doppler scan. Results of the cross validation confirmed the trends in the two data sets. CONCLUSION Quantitative Doppler US vascularity measurements considerably contribute to malignant breast tissue identification beyond subjective GS evaluation alone. The SWPD-age-GS index has high performance (A(z) = 0.97), regardless of incidental performance variations in its single variable components.
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Scholbach T, Scholbach J, Krombach GA, Gagel B, Maneschi P, Di Martino E. New method of dynamic color doppler signal quantification in metastatic lymph nodes compared to direct polarographic measurements of tissue oxygenation. Int J Cancer 2005; 114:957-62. [PMID: 15645426 DOI: 10.1002/ijc.20827] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tumor growth depends on sufficient blood and oxygen supply. Hypoxia stimulates neovascularization and is a known cause for radio- and chemoresistance. The objective of this study was to investigate the use of a novel ultrasound technique for the dynamic assessment of vascularization and oxygenation in metastatic lymph nodes. Twenty-four patients (age 44-78 years) with cervical lymph node metastases of squamous cell head and neck cancer were investigated by color duplex sonography and 17 (age 46-78 years) were investigated additionally with polarography. Sonography was performed after contrast enhancer infusion under defined conditions. Intranodal perfusion data (color hue, colored area) were measured automatically by a novel software technique. This allows an evaluation of blood flow dynamics by calculating perfusion intensity--velocity, perfused area, as well as the novel parameters tissue resistance index (TRI) and tissue pulsatility index (TPI)--for each point of a complete heart cycle. Tumor tissue pO(2) was measured by means of polarographic needle electrodes placed intranodally. The sonographic and polarographic data were correlated using Pearson's test. Sonography demonstrated a statistically significant inverse correlation between hypoxia and perfusion and significant TPI and TRI changes with different N-stages. The percentage of nodal fraction with less than 10 mmHg oxygen saturation was significantly inversely correlated with lymph node perfusion (r = -0.551; p = 0.021). Nodes with a perfusion of less than 0.05 cm/sec flow velocity showed significantly larger hypoxic areas (p = 0.006). Significant differences of TPI and TRI existed between nodes in stage N(1) and N(2)/N(3) (p = 0.028 and 0.048, respectively). This new method of dynamic signal quantification allows a noninvasive and quantitative assessment of tumor and metastatic lymph node perfusion by means of commonly available ultrasound equipment.
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Affiliation(s)
- Thomas Scholbach
- Kinderklinik am Städtischen Klinikum St. Georg, D-04229 Leipzig, Germany.
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Strano S, Gombos EC, Friedland O, Mozes M. Color Doppler imaging of fibroadenomas of the breast with histopathologic correlation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2004; 32:317-322. [PMID: 15293297 DOI: 10.1002/jcu.20041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE This study was conducted to characterize the spatial distribution of blood vessels in breast fibroadenomas. METHODS We performed a prospective study to map the anatomic distribution of the vessels in 29 fibroadenomas of the breast using color Doppler sonography. We categorized the detected vessels according to their location in or on the fibroadenoma, counted the different types of vessels, and tested for correlations between vessel distributions or numbers and histopathologic findings. RESULTS Blood flow was demonstrated in 24/29 (83%) of fibroadenomas. We found 3 vessel types: feeding vessels, which are prominent vessels leading from the surrounding breast tissue into the fibroadenoma; capsular vessels, which are located within the tissue capsule; and segmental vessels, which are located within the fibrous septa of the fibroadenoma. Capsular and segmental vessels were demonstrated in 23/24 (96%) and 24/24 (100%) of the cases, respectively. Feeding vessels were seen in 12/24 (50%) of the cases. Histopathologic analysis revealed the same location and distribution of the vessels as color Doppler imaging. However, there was no correlation between numbers of vessels counted on sonograms and on histopathologic specimens. CONCLUSIONS Examination of the vascularity demonstrated on color Doppler imaging helps in the diagnosis of benign breast neoplasms such as fibroadenomas.
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Affiliation(s)
- Selwyn Strano
- Rachel Nash Comprehensive Breast Center, Bet Ofer, 5 Nachum Heftzadi St., Jerusalem, 95484, Israel
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Lee SW, Choi HY, Baek SY, Lim SM. Role of color and power doppler imaging in differentiating between malignant and benign solid breast masses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2002; 30:459-464. [PMID: 12242733 DOI: 10.1002/jcu.10100] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE This study analyzed the color and power Doppler signals in solid breast masses and assessed their value in differentiating malignant from benign lesions. METHODS One hundred twenty-nine biopsy-proven solid breast masses (54 malignant and 75 benign) were evaluated with color and/or power Doppler sonography using a 7-MHz linear-array transducer. We retrospectively analyzed the location, shape, and penetration of the Doppler vascular signals in the breast masses. The location of the vascular signals was categorized as central, peripheral, or both. The shape of the signals was categorized as linear, irregular, branching, or a single dot. A penetrating vessel was defined as a continuous vascular signal extending from outside the lesion to inside it. In 43 cases, power and color Doppler sonograms were compared. RESULTS Doppler features suggestive of malignant lesions were the presence of both peripheral and central vascularity (odds ratio, 6.0), presence of penetrating vessels (odds ratio, 5.4), and presence of branching vessels (odds ratio, 13.7). Power Doppler sonography was more sensitive than color Doppler sonography in detecting vascular signals in 49% of cases. CONCLUSIONS Color (power) Doppler imaging is a valuable adjunct to conventional sonography in differentiating between malignant and benign breast lesions.
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Affiliation(s)
- Sheen-Woo Lee
- Department of Diagnostic Radiology, Ewha Womans University Hospital Medical Research Center, 911-1 MokDong, YangcheonGu, Seoul 158-710, South Korea
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Germer U, Tetzlaff A, Geipel A, Diedrich K, Gembruch U. Strong impact of estrogen environment on Doppler variables used for differentiation between benign and malignant breast lesions. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2002; 19:380-385. [PMID: 11952968 DOI: 10.1046/j.1469-0705.2002.00675.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES To analyze the impact of an estrogen environment on the Doppler variables usually used for differentiation between benign and malignant lesions. METHODS A total of 142 malignant and 107 benign breast lesions was demonstrated (in 91 premenopausal and 152 postmenopausal patients) by B-mode ultrasound. Intratumoral vessels were visualized by color Doppler and blood flow velocity waveforms were analyzed by pulsed Doppler. The number of intratumoral vessels and the Doppler variables, peak systolic velocity, resistance and pulsatility indices and the peak systolic/diastolic ratio were evaluated in different endocrine milieus represented by menopausal status, phase of the menstrual cycle, intake of oral contraceptives or hormone replacement therapy. RESULTS In malignant tumors the Doppler variables resistance and pulsatility indices and the systolic/diastolic ratio were significantly higher in postmenopausal women than in premenopausal women. In benign tumors significantly higher values of resistance and pulsatility indices were also detected in post- compared to premenopausal women (P < or = 0.05). In premenopausal patients with benign tumors taking oral contraceptives the number of intratumoral vessels was significantly higher, while resistance index and systolic/diastolic ratio values were decreased compared to patients with spontaneous menstrual cycles. In postmenopausal patients hormone replacement therapy did not influence Doppler variables in the benign or the malignant groups. CONCLUSION Our results demonstrate a robust influence of menopausal status and oral contraceptives on Doppler variables of breast lesions. We believe it is likely that some of the differences in the Doppler variables found in reports comparing benign and malignant breast lesions were caused by their association with a pre- or postmenopausal status.
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Affiliation(s)
- U Germer
- Department of Gynecology and Obstetrics, Medical University of Lübeck, Lübeck, Germany.
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Moon WK, Im JG, Noh DY, Han MC. Nonpalpable breast lesions: evaluation with power Doppler US and a microbubble contrast agent-initial experience. Radiology 2000; 217:240-6. [PMID: 11012451 DOI: 10.1148/radiology.217.1.r00oc03240] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate power Doppler ultrasonography (US) performed with a microbubble US contrast agent in the differentiation of nonpalpable breast lesions. MATERIALS AND METHODS Fifty nonpalpable breast lesions in 50 patients were prospectively evaluated with power Doppler US before and after injection of the contrast agent SH U 508A. Lesion vascularity and the morphology of vessels on US scans were analyzed and were correlated with histologic results. RESULTS Surgical excision revealed 22 cancers and 28 benign lesions. At nonenhanced power Doppler US, eight (36%) of 22 cancers and four (14%) of 28 benign lesions were vascular. At contrast agent-enhanced power Doppler US, 21 (95%) cancers and six (21%) benign lesions were vascular (P <.001). Irregular vessels were seen in three cancers and one benign lesion at nonenhanced power Doppler US and in 11 cancers and one benign lesion at contrast-enhanced power Doppler US. By using the presence of vascularity in the mass as the diagnostic criterion for malignancy, the sensitivity, specificity, and positive and negative predictive values of power Doppler US changed from 36%, 86%, 67%, and 63%, respectively, to 95%, 79%, 78%, and 96% after contrast agent injection. CONCLUSION Contrast-enhanced power Doppler US was superior to nonenhanced power Doppler US in the demonstration and characterization of tumor vascularity in nonpalpable breast lesions. Contrast-enhanced power Doppler US may be useful for the differentiation between nonpalpable breast cancers and benign tumors.
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Affiliation(s)
- W K Moon
- Departments of Radiology and Surgery, the Clinical Research Institute, Seoul National University Hospital and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
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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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Douek M, Davidson T, Taylor I. Breast cancer imaging--what are the optimal modalities? Eur J Surg Oncol 1998; 24:573-82. [PMID: 9870737 DOI: 10.1016/s0748-7983(98)93824-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- M Douek
- Department of Surgery, Royal Free University College London Medical School, UK
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Abstract
The authors report the results obtained with color Doppler sonography in the study of breast conditions. Color Doppler allows to detect the following main features in breast conditions: the presence of blood flow, vessel arrangement, vascularization extent, the number of vascular poles. To investigate slow flows, it is better to use low PRF values (not above 1 KHz) and low filters, while amplification should be set immediately above the system's noise threshold; the size of color Doppler box should be adjusted as small as possible to maximize sensitivity and minimize flash artifacts. In May 1992 to September 1997, 252 patients with solid breast masses were examined with mammography, B-mode, color Doppler and power Doppler sonography (only 57 cases). We identified histologically (176 cases) or cytologically (77 cases) 141 carcinomas and 112 benign solid lesions. The diameter of the 141 carcinomas ranged 0.4-4 cm (mean 1.7), while the diameter of benign lesions ranged 0.7-3 cm (mean 1.5). The malignancy pattern was characterized by hypervascularity (92.9%), irregular and abundant (54.2%) vascularization and more than one vascular pole. Benign lesions were avascular (43.4%) with poor and peripheral vascularity (90%) and mostly showed only one vascular pole. The avascular cancers (10 cases) were three mucoid, five in situ and two small (0.7 and 0.9 cm) invasive ductal carcinomas. The six benign lesions with irregular and abundant vascularization and more than one vascular pole were proved to be two proliferating and three juvenile fibroadenomas and one phylloid tumor. These results are encouraging and suggest that this technique can be a useful adjunct to mammography and sonography in the differential, diagnosis of breast nodules.
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Affiliation(s)
- G M Giuseppetti
- Institute of Diagnostic Semiology and Instrumental Therapy, University of Ancona, Italy
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