Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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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

  • Ah Young Park (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Myoungae Kwon (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Ok Hee Woo (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kyu Ran Cho (Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Eun Kyung Park (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Sang Hoon Cha (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Sung Eun Song (Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine) ;
  • Ju-Han Lee (Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • JaeHyung Cha (Medical Science Research Center, Korea University Ansan Hospital) ;
  • Gil Soo Son (Division of Breast Endocrine Surgery, Department of General Surgery, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Bo Kyoung Seo (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine)
  • Received : 2018.08.03
  • Accepted : 2018.12.22
  • Published : 2019.05.01
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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.

Keywords

Acknowledgement

This study was supoorted by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science, ICT & Future Planning; MSIP) (No. NRF-2017R1A2B4010178) and Canon Medical Systems Korea Co.,Ltd.

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