Korean J Radiol.  2019 May;20(5):759-772. 10.3348/kjr.2018.0515.

A Prospective Study on the Value of Ultrasound Microflow Assessment to Distinguish Malignant from Benign Solid Breast Masses: Association between Ultrasound Parameters and Histologic Microvessel Densities

Affiliations
  • 1Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea. seoboky@korea.ac.kr
  • 2Department of Radiology, Bundang CHA Medical Center, CHA University, Seongnam, Korea.
  • 3Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
  • 4Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
  • 5Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
  • 6Medical Science Research Center, Korea University Ansan Hospital, Ansan, Korea.
  • 7Division of Breast Endocrine Surgery, Department of General Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.

Abstract


OBJECTIVE
To investigate the value of ultrasound (US) microflow assessment in distinguishing malignant from benign solid breast masses as well as the association between US parameters and histologic microvessel density (MVD).
MATERIALS AND METHODS
Ninety-eight breast masses (57 benign and 41 malignant) were examined using Superb Microvascular Imaging (SMI) and contrast-enhanced US (CEUS) before biopsy. Two radiologists evaluated the quantitative and qualitative vascular parameters on SMI (vascular index, morphology, distribution, and penetration) and CEUS (time-intensity curve analysis and enhancement characteristics). US parameters were compared between benign and malignant masses and the diagnostic performance was compared between SMI and CEUS. Subgroup analysis was performed according to lesion size. The effect of vascular parameters on downgrading Breast Imaging Reporting and Data System (BI-RADS) category 4A masses was evaluated. The association between histologic MVD and US parameters was analyzed.
RESULTS
Malignant masses were associated with a higher vascular index (15.1 ± 7.3 vs. 5.9 ± 5.6), complex vessel morphology (82.9% vs. 42.1%), central vascularity (95.1% vs. 59.6%), penetrating vessels (80.5% vs. 31.6%) on SMI (all, p < 0.001), as well as higher peak intensity (37.1 ± 25.7 vs. 17.0 ± 15.8, p < 0.001), slope (10.6 ± 11.2 vs. 3.9 ± 4.2, p = 0.001), area (1035.7 ± 726.9 vs. 458.2 ± 410.2, p < 0.001), hyperenhancement (95.1% vs. 70.2%, p = 0.005), centripetal enhancement (70.7% vs. 45.6%, p = 0.023), penetrating vessels (65.9% vs. 22.8%, p < 0.001), and perfusion defects (31.7% vs. 3.5%, p < 0.001) on CEUS (p ≤ 0.023). The areas under the receiver operating characteristic curve (AUCs) of SMI and CEUS were 0.853 and 0.841, respectively (p = 0.803). In 19 masses measuring < 10 mm, central vascularity on SMI was associated with malignancy (100% vs. 38.5%, p = 0.018). Considering all benign SMI parameters on the BI-RADS assessment, unnecessary biopsies could be avoided in 12 category 4A masses with improved AUCs (0.500 vs. 0.605, p < 0.001). US vascular parameters associated with malignancy showed higher MVD (p ≤ 0.016). MVD was higher in malignant masses than in benign masses, and malignant masses negative for estrogen receptor or positive for Ki67 had higher MVD (p < 0.05).
CONCLUSION
US microflow assessment using SMI and CEUS is valuable in distinguishing malignant from benign solid breast masses, and US vascular parameters are associated with histologic MVD.

Keyword

Contrast-enhanced ultrasound (CEUS); Breast cancer; Microvessel density; Doppler; Ultrasonography
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