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Mohindra N, Soni N. Ultrasound-Based Noncontrast Microvascular Imaging for Evaluation of Breast Lesions: Imaging Techniques and Review of Diagnostic Criteria. Indian J Radiol Imaging 2024; 34:702-713. [PMID: 39318571 PMCID: PMC11419773 DOI: 10.1055/s-0044-1782162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Abstract
Vascularity plays a pivotal role in the progression of breast lesions and may be associated with their aggressiveness and likelihood of being malignant. Contrast-enhanced imaging techniques are necessary to evaluate vascularity due to the limited sensitivity of conventional color Doppler techniques, in which motion artifacts are eliminated using wall filters. However, in this process, low-flow signals from small vessels also get removed unintentionally. Advancements in technology have revolutionized the way ultrasound images are generated, resulting in tremendous improvements in Doppler imaging techniques. The new, ultrasound-based noncontrast microvascular imaging techniques overcome the limitations of conventional Doppler, and are highly sensitive for detecting microvessels and low flow. The resultant high Doppler sensitivity leads to detection of vascularity in more breast lesions. It is important for radiologists to understand the imaging principles and the clinical implications of the new techniques, to optimally utilize them and aid correct diagnosis. Angio-PLUS is one such recent advancement, which uses unfocused or plane waves and three-dimensional wall filtering to analyze tissue motion in time, space, and amplitude domains that effectively distinguish between blood flow and tissue. The information is beneficial for assessing the lesion vascularity without using contrast. This article aims to explain the Doppler imaging techniques, their clinical applications, scanning methods, and review the common Doppler-based diagnostic criteria used in the evaluation of breast lesions.
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Affiliation(s)
- Namita Mohindra
- Department of Radio-diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh, India
| | - Neetu Soni
- Radiology, Mayo Clinic, Jacksonville, Florida, United States
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Zhang W, Sun J, Li J, Wang Y, Liu W, Xue W, Yuan Y, Wang X. Comparison of Angio PLanewave UltraSensitive and Power Doppler Ultrasound in Detecting Synovial Blood Flow in Wrist and Finger Joints of Rheumatoid Arthritis Patients. Acad Radiol 2024; 31:1528-1537. [PMID: 37777427 DOI: 10.1016/j.acra.2023.09.006] [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: 07/23/2023] [Revised: 08/19/2023] [Accepted: 09/03/2023] [Indexed: 10/02/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to conduct a comparison between the newly introduced Angio PLanewave UltraSensitive (AngioPLUS) method and the power Doppler ultrasound (PDUS) technique, evaluating the efficacy of these two methods in detecting synovial blood flow in wrist and finger joints of rheumatoid arthritis (RA) patients. Furthermore, the study aimed to investigate the potential associations between the observed blood flow patterns and various symptoms and indicators associated with RA. MATERIALS AND METHODS A cohort of 101 patients diagnosed with RA was included and subsequently categorized into two groups: 20 male participants (19.80%) and 81 female participants (80.20%). Their grayscale ultrasound, PDUS, and AngioPLUS were utilized to acquire data, and subsequent scoring was conducted. Serological tests of the patients were also performed, and DAS28 scores were calculated. The McNemar and Wilcoxon tests were used to compare the blood flow display rate and grading of PDUS as well as AngioPLUS, respectively. RESULTS AngioPLUS blood was significantly improved compared to PDUS. In all joints, the proportion of slight and significant improvement in wrist joints was the highest (14.11% and 1.98%, respectively). AngioPLUS was moderately correlated with C-reactive Protein (CRP), Disease Activity Score that includes 28-joint counts, and swollen joint counts and weakly correlated with platelet, hemoglobin, tender joint counts, and CRP before and after treatment. CONCLUSION Compared to PDUS, AngioPLUS has a better auxiliary diagnostic role in evaluating disease activity and can provide a reference to improve the management of RA further.
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Affiliation(s)
- Wuyue Zhang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Jiawei Sun
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Jinyao Li
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Yanyan Wang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Weiyao Liu
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Weili Xue
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.)
| | - Yan Yuan
- Ultrasound Department, Heilongjiang Red Cross Sengong General Hospital, Harbin, China (Y.Y.)
| | - Xiaolei Wang
- In-Patient Ultrasound Department, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, NanGang District, Harbin, 150086, China (W.Z., J.S., J.L., Y.W., W.L., W.X., X.W.).
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Bhargava A, Popel AS, Pathak AP. Vascular phenotyping of the invasive front in breast cancer using a 3D angiogenesis atlas. Microvasc Res 2023; 149:104555. [PMID: 37257688 PMCID: PMC10526652 DOI: 10.1016/j.mvr.2023.104555] [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: 02/23/2023] [Revised: 05/02/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Vascular remodeling at the invasive tumor front (ITF) plays a critical role in progression and metastasis of triple negative breast cancer (TNBC). Therefore, there is a crucial need to characterize the vascular phenotype (i.e. changes in the structure and function of vasculature) of the ITF and tumor core (TC) in TNBC. This requires high-resolution, 3D structural and functional microvascular data that spans the ITF and TC (i.e. ∼4-5 mm from the tumor's edge). Since such data are often challenging to obtain with most conventional imaging approaches, we employed a unique "3D whole-tumor angiogenesis atlas" derived from orthotopic xenografts to characterize the vascular phenotype of the ITF and TC in TNBC. METHODS First, high-resolution (8 μm) computed tomography (CT) images of "whole-tumor" microvasculature were acquired from eight orthotopic TNBC xenografts, of which three tumors were excised at post-inoculation day 21 (i.e. early-stage) and five tumors were excised at post-inoculation day 35 (i.e. advanced-stage). These 3D morphological CT data were combined with soft tissue contrast from MRI as well as functional data generated in silico using image-based hemodynamic modeling to generate a multi-layered "angiogenesis atlas". Employing this atlas, blood vessels were first spatially stratified within the ITF (i.e. ≤1 mm from the tumor's edge) and TC (i.e. >1 mm from the tumor's edge) of each tumor xenograft. Then, a novel method was developed to visualize and characterize microvascular remodeling and perfusion changes in terms of distance from the tumor's edge. RESULTS The angiogenesis atlas enabled the 3D visualization of changes in tumor vessel growth patterns, morphology and perfusion within the ITF and TC. Early and advanced stage tumors demonstrated significant differences in terms of their edge-to-center distributions for vascular surface area density, vascular length density, intervessel distance and simulated perfusion density (p ≪ 0.01). Elevated vascular length density, vascular surface area density and perfusion density along the circumference of the ITF was suggestive of a preferential spatial pattern of angiogenic growth in this tumor cohort. Finally, we demonstrated the feasibility of differentiating the vascular phenotypes of ITF and TC in these TNBC xenografts. CONCLUSIONS The combination of a 3D angiogenesis atlas and image-based hemodynamic modeling heralds a new approach for characterizing the role of vascular remodeling in cancer and other diseases.
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Affiliation(s)
- Akanksha Bhargava
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aleksander S Popel
- Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Electrical Engineering, Johns Hopkins University
| | - Arvind P Pathak
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Electrical Engineering, Johns Hopkins University; Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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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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Catalano O, Fusco R, De Muzio F, Simonetti I, Palumbo P, Bruno F, Borgheresi A, Agostini A, Gabelloni M, Varelli C, Barile A, Giovagnoni A, Gandolfo N, Miele V, Granata V. Recent Advances in Ultrasound Breast Imaging: From Industry to Clinical Practice. Diagnostics (Basel) 2023; 13:diagnostics13050980. [PMID: 36900124 PMCID: PMC10000574 DOI: 10.3390/diagnostics13050980] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Breast ultrasound (US) has undergone dramatic technological improvement through recent decades, moving from a low spatial resolution, grayscale-limited technique to a highly performing, multiparametric modality. In this review, we first focus on the spectrum of technical tools that have become commercially available, including new microvasculature imaging modalities, high-frequency transducers, extended field-of-view scanning, elastography, contrast-enhanced US, MicroPure, 3D US, automated US, S-Detect, nomograms, images fusion, and virtual navigation. In the subsequent section, we discuss the broadened current application of US in breast clinical scenarios, distinguishing among primary US, complementary US, and second-look US. Finally, we mention the still ongoing limitations and the challenging aspects of breast US.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, Istituto Diagnostico Varelli, 80126 Naples, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Correspondence:
| | - Federica De Muzio
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Igino Simonetti
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, 80131 Naples, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Federico Bruno
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, 67100 L’Aquila, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Michela Gabelloni
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, 56126 Pisa, Italy
| | - Carlo Varelli
- Department of Radiology, Istituto Diagnostico Varelli, 80126 Naples, Italy
| | - Antonio Barile
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, 67100 L’Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy
- Department of Radiology, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Vincenza Granata
- Division of Radiology, “Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli”, 80131 Naples, Italy
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A Novel Nomogram Based on Imaging Biomarkers of Shear Wave Elastography, Angio Planewave Ultrasensitive Imaging, and Conventional Ultrasound for Preoperative Prediction of Malignancy in Patients with Breast Lesions. Diagnostics (Basel) 2023; 13:diagnostics13030540. [PMID: 36766645 PMCID: PMC9914566 DOI: 10.3390/diagnostics13030540] [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: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Several studies have demonstrated the difficulties in distinguishing malignant lesions of the breast from benign lesions owing to overlapping morphological features on ultrasound. Consequently, we aimed to develop a nomogram based on shear wave elastography (SWE), Angio Planewave Ultrasensitive imaging (Angio PLUS (AP)), and conventional ultrasound imaging biomarkers to predict malignancy in patients with breast lesions. This prospective study included 117 female patients with suspicious lesions of the breast. Features of lesions were extracted from SWE, AP, and conventional ultrasound images. The least absolute shrinkage and selection operator (Lasso) algorithms were used to select breast cancer-related imaging biomarkers, and a nomogram was developed based on six of the 16 imaging biomarkers. This model exhibited good discrimination (area under the receiver operating characteristic curve (AUC): 0.969; 95% confidence interval (CI): 0.928, 0.989) between malignant and benign breast lesions. Moreover, the nomogram also showed demonstrated good calibration and clinical usefulness. In conclusion, our nomogram can be a potentially useful tool for individually-tailored diagnosis of breast tumors in clinical practice.
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Chen J, Liu D, Wang J, Song W, Ma F. Clinical application of super sensitive microflow ultrasound on the detection of intraplaque neovascularization in patients with atheromatous carotid artery plaque. Clin Hemorheol Microcirc 2022; 82:283-293. [PMID: 35912734 DOI: 10.3233/ch-221510] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a routine technique for detecting intraplaque neovascularization (IPN). However, the invasiveness and complexity of CEUS severely limit its clinical application. This article aims to investigate the application value of AngioPLUS (AP) technique in assessing IPN formation in patients with atheromatous (AS) carotid artery plaque. METHODS Patients diagnosed with carotid artery atherosclerosis combined plaque formation were recruited and their demographic characteristics including serum fasting blood glucose (FBG), triglyceride (TG), and low-density lipoprotein (LDL) were collected. AP was used to scoring intraplaque microvascular flow (IMVF), measuring the thickness and length of the plaque and determining the number of IPN of the plaque. RESULTS IMVF score evaluated by AP was positively correlated with plaque length, thickness, IPN number, serum TG, LDL and FBG levels in patients with carotid atherosclerosis with plaque. The evaluation results of CEUS score and IMVF classification detected by AP of plaques were consistent in patients with carotid atherosclerosis. CONCLUSION IMVF scoring by AP is a promising approach to assess IPN and plaque status in patients with atheromatous carotid artery plaque.
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Affiliation(s)
- Jin Chen
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Dandan Liu
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Jing Wang
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Wanji Song
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Fang Ma
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
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Zhang XY, Cai SM, Zhang L, Zhu QL, Sun Q, Jiang YX, Wang HY, Li JC. Association Between Vascular Index Measured via Superb Microvascular Imaging and Molecular Subtype of Breast Cancer. Front Oncol 2022; 12:861151. [PMID: 35387128 PMCID: PMC8979674 DOI: 10.3389/fonc.2022.861151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background To determine whether vascular index (VI; defined as the ratio of Doppler signal pixels to pixels in the total lesion) measured via superb microvascular imaging in breast cancer correlates with immunohistochemically defined subtype and is able to predict molecular subtypes. Methods This prospective study involved 225 patients with 225 mass-type invasive breast cancers (mean size 2.6 ± 1.4 cm, range 0.4~5.9 cm) who underwent ultrasound and superb microvascular imaging (SMI) at Peking Union Medical College Hospital before breast surgery from December 2016 to June 2018. The correlations between primary tumor VI measured via SMI, clinicopathological findings, and molecular subtype were analyzed. The performance of VI for prediction of molecular subtypes in invasive breast cancer was investigated. Results The median VI of the 225 tumors was 7.3% (4.2%~11.8%) (range 0%~54.4%). Among the subtypes of the 225 tumors, 41 (18.2%) were luminal A, 91 (40.4%) were luminal B human epidermal growth factor receptor-2 (HER-2)-negative, 26 (11.6%) were luminal B HER-2-positive, 17 (7.6%) were HER-2-positive, and 50 (22.2%) were triple-negative, and the corresponding median VI values were 5.9% (2.6%~11.6%) (range 0%~47.1%), 7.3 (4.4%~10.5%) (range 0%~29.5%), 6.3% (3.9%~11.3%) (range 0.6%~22.2%), 8.2% (4.9%~15.6%) (range 0.9%~54.4%), and 9.2% (5.1%~15.3%) (range 0.7%~32.9%), respectively. Estrogen receptor (ER) negativity, higher tumor grade, and higher Ki-67 index (≥20%) were significantly associated with a higher VI value. Tumor size, ER status, and Ki-67 index were shown to independently influence VI. A cutoff value of 4.1% yielded 79.9% sensitivity and 41.5% specificity with an area under the receiver operating characteristic curve (AUC) of 0.58 for predicting that a tumor was of the luminal A subtype. A cutoff value of 16.4% yielded 30.0% sensitivity and 90.3% specificity with an AUC of 0.60 for predicting a triple-negative subtype. Conclusions VI, as a quantitative index obtained by SMI examination, could reflect histologic vascular changes in invasive breast cancer and was found to be higher in more biologically aggressive breast tumors. VI shows a certain degree of correlation with the molecular subtype of invasive breast cancer and plays a limited role in predicting the luminal A with high sensitivity and triple-negative subtype with high specificity.
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Affiliation(s)
- Xiao-Yan Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Si-Man Cai
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qing-Li Zhu
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu-Xin Jiang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong-Yan Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian-Chu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Zhang Y, Sun X, Li J, Gao Q, Guo X, Liu JX, Gan W, Yang S. The diagnostic value of contrast-enhanced ultrasound and superb microvascular imaging in differentiating benign from malignant solid breast lesions: A systematic review and meta-analysis. Clin Hemorheol Microcirc 2022; 81:109-121. [PMID: 35180108 DOI: 10.3233/ch-211367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the added value of contrast-enhanced ultrasound (CEUS) and superb microvascular imaging (SMI) to the conventional ultrasound (US) in the diagnosis of breast lesions. METHODS PubMed, EMBASE, Web of Science, Chinese national knowledge infrastructure databases, Chinese biomedical literature databases, and Wanfang were searched for relevant studies from November 2015 to November 2021. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Studies (QUADAS) tool. Meta-Disc version 1.4 was used to calculate sensitivity (SEN), specificity (SPE), positive likelihood ratio (LR +), negative likelihood ratio (LR-), area under curve (AUC), and diagnostic odds ratio (DOR). Meta-regression analysis was performed using STATA 16.0 software to compare the diagnostic accuracy of the two techniques. RESULTS In the five studies included, 530 patients were eligible for this meta-analysis. For SMI, the pooled SEN and SPE were 0.75 (95% confidence interval [CI]: 0.69-0.91) and 0.88 (95% CI: 0.83-0.91), respectively, LR + was 5.75 (95% CI: 4.26-7.78), LR- was 0.29 (95% CI: 0.23-0.36), DOR was 21.42 (95% CI, 13.61-33.73), and AUC was 0.8871. For CEUS, the pooled SEN and SPE were 0.87 (95% CI: 0.82-0.91) and 0.86 (95% CI: 0.82-0.89), respectively, LR + was 5.92 (95% CI: 4.21-8.33), LR- was 0.16 (95% CI: 0.11-0.25), DOR was 38.27 (95% CI: 18.73-78.17), and AUC was 0.9210. CONCLUSIONS Adding CEUS and (or) SMI to conventional US could improve its diagnostic performance in differentiating benign from malignant solid breast lesions.
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Affiliation(s)
- Yi Zhang
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaofeng Sun
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jingjing Li
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Gao
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaofei Guo
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian-Xin Liu
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenyuan Gan
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shunshi Yang
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Chen C, Liu S, Zhao C, Wang R, Yu N, Long X, Wang Y, Yang F, Sun J, Lu ZL, Xia Y, Jiang Y, Yang M. Activity of keloids evaluated by multimodal photoacoustic/ultrasonic imaging system. PHOTOACOUSTICS 2021; 24:100302. [PMID: 34540586 PMCID: PMC8441086 DOI: 10.1016/j.pacs.2021.100302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/25/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
Multiple objective assessments have been used to assess the activity of keloids to compare different therapeutic regimens and facilitate the best individual treatment choice for patients, but none of them are standardized. A multimodal photoacoustic/ultrasonic (PA/US) imaging system, including photoacoustic imaging, elastography, ultra-micro-angiography, and conventional US technologies (gray scale US, color Doppler US, and power Doppler US), was applied to evaluate keloids by a radiologist. Growing stages were defined by patients, and Vancouver Scar Scale (VSS) was assessed by a plastic surgeon. A comprehensive model based on multimodal ultrasound parameters (poor-echo pattern, high vascular density, decreased elasticity, and low SO2 within the keloid) and VSS might be a potential indicator of active keloids, comparing with VSS alone. The multimodal PA/US imaging system could be a promising technique for keloids assessment.
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Affiliation(s)
- Cheng Chen
- Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sirui Liu
- Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenyang Zhao
- Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ruojiao Wang
- Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youbin Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fang Yang
- Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Jie Sun
- Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China
| | - Zhao Ling Lu
- Mindray North American Innovation Center, San Jose, CA, United States
| | - Yu Xia
- Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Yang
- Department of Ultrasonography, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Park AY, Seo BK, Han MR. Breast Ultrasound Microvascular Imaging and Radiogenomics. Korean J Radiol 2021; 22:677-687. [PMID: 33569931 PMCID: PMC8076833 DOI: 10.3348/kjr.2020.1166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/13/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023] Open
Abstract
Microvascular ultrasound (US) techniques are advanced Doppler techniques that provide high sensitivity and spatial resolution for detailed visualization of low-flow vessels. Microvascular US imaging can be applied to breast lesion evaluation with or without US contrast agents. Microvascular US imaging without a contrast agent uses a sophisticated wall filtering system to selectively obtain low-flow Doppler signals from overlapped artifacts. Microvascular US imaging with second-generation contrast agents amplifies flow signals and makes them last longer, which facilitates hemodynamic evaluation of breast lesions. In this review article, we will introduce various microvascular US techniques, explain their clinical applications in breast cancer diagnosis and radiologic-histopathologic correlation, and provide a summary of a recent radiogenomic study using microvascular US.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
| | - Mi Ryung Han
- Division of Life Sciences, College of Life Sciences and Bioengineering, Incheon National University, Incheon, Korea
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Son MJ, Kim S, Jung HK, Ko KH, Koh JE, Park AY. Can Ultrasonographic Vascular and Elastographic Features of Invasive Ductal Breast Carcinoma Predict Histologic Aggressiveness? Acad Radiol 2020; 27:487-496. [PMID: 31300357 DOI: 10.1016/j.acra.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/07/2019] [Accepted: 06/15/2019] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate if preoperative ultrasonographic vascular and shear-wave elastographic examinations can predict histologic aggressiveness. MATERIALS AND METHODS Preoperative ultrasonographic vascular features and shear-wave elasticities were retrospectively evaluated for 147 invasive ductal carcinomas. Vascular feature was assessed using four-tier vascularity score. Mean and maximum elasticities (Emean and Emax), and the lesion-to-fat ratio (Eratio) were documented. Histologic parameters were reviewed for tumor size, multiplicity, axillary lymph node status, lymphovascular invasion, histologic grade, estrogen receptor, progesterone receptor, human epidermal growth factor receptor2 (HER2), Ki-67, p53, and histologic subtype. Vascularity score and elasticities were correlated with histologic parameters and histologic parameters were compared between the group with low vascularity score and elasticities and the group with high vascularity score and elasticities using ANOVA, chi-squared test, and regression analysis. RESULTS Vascularity score was independently associated with tumor size (p = 0.010) and HER2 (p = 0.007). Emean and Emax were associated with tumor size, histologic grade, and lymphovascular invasion, and Eratio was associated with tumor size, histologic grade, estrogen receptor, progesterone receptor, Ki-67, and histologic subtype (p < 0.05). Emean and Emax were independently associated with tumor size (p < 0.001). The group with high vascularity score and Eratio showed large tumor size (p < 0.001) and HER2 positivity (p = 0.039) in comparison to the group with low vascularity score and Eratio. CONCLUSION Ultrasonographic vascular features were associated with tumor size and HER2. SWE elasticities were associated with tumor size, histologic grade, hormonal receptor, and histologic subtype. Therefore, preoperative vascular and elastographic examinations could predict histologic aggressiveness of invasive ductal breast carcinoma.
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Zhu X, Ding C. Letter by Zhu and Ding Regarding Article, "Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media". Stroke 2020; 51:e11. [PMID: 31813357 DOI: 10.1161/strokeaha.119.027872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xiaoxia Zhu
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, P.R. China
| | - Chandong Ding
- Department of Cardiology, The Second Affiliated Hospital of Anhui Medical University, P.R. China
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