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Abougazia A, York J, Erdelyi G, Aryasomayajula S, Evans A. Reproducibility and diagnostic performance of superb microvascular Imaging's vascular index in solid breast lesions. Clin Radiol 2025; 82:106773. [PMID: 39842181 DOI: 10.1016/j.crad.2024.106773] [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: 09/17/2024] [Revised: 12/03/2024] [Accepted: 12/06/2024] [Indexed: 01/24/2025]
Abstract
AIM Superb microvascular imaging (SMI) is a new ultrasound tool that can detect small blood vessels while cancelling out artefacts. It may be useful in detecting the vascularity associated with malignant breast lesions. This study evaluated the reproducibility and diagnostic performance of SMI's Vascular Index (VI) in differentiating benign from malignant solid breast lesions. MATERIALS AND METHODS Solid breast lesions were prospectively assessed by two observers before core biopsy. Each lesion was given BIRADS score, and SMI VI was measured. The reproducibility and diagnostic performance of SMI VI were assessed by the intraclass correlation coefficient (ICC) and by the area under the receiver operating characteristics (AUROC) curve, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS 121 lesions in 115 patients were assessed, of which 53 were malignant and 68 benign. The ICC for SMI VI readings was 0.72. The SMI VI AUROC was 0.61, the sensitivity was 90.4%, specificity of 31.9%, PPV of 50% and NPV of 81.5%. The BIRADS scores in all lesions had an AUROC of 0.78, sensitivity of 100%, specificity of 55.1%, PPV of 62.7%, and NPV of 100%. CONCLUSION This is the first study to assess the reproducibility and diagnostic performance of SMI VI in differentiating benign from malignant breast lesions in a European population. We have shown that SMI VI is poor at differentiating benign from malignant breast lesions, and therefore reproducibility is irrelevant in this context. Future studies may find other uses for SMI's depiction of lesion vascularity.
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Affiliation(s)
- A Abougazia
- Breast Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3NE, UK.
| | - J York
- Breast Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3NE, UK
| | - G Erdelyi
- Breast Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3NE, UK
| | - S Aryasomayajula
- Breast Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3NE, UK
| | - A Evans
- Breast Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3NE, UK
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Li Y, Li H, Du L, Shi Q, Li G, Jia C, Jin L, Liang H, Li F. Construction of a multi-parametric ultrasonographic nomogram for precise assessment of papillary breast lesions. Br J Radiol 2025; 98:422-431. [PMID: 39656793 DOI: 10.1093/bjr/tqae242] [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: 02/01/2024] [Revised: 09/22/2024] [Accepted: 11/26/2024] [Indexed: 12/17/2024] Open
Abstract
OBJECTIVES To analyze the multi-parametric ultrasonographic (MpUS) features of atypical/malignant papillary lesions of the breast with clinical information, identify independent risk factors, and construct a nomogram to improve the diagnostic accuracy. METHODS This retrospective study analyzed consecutively hospitalized patients diagnosed with pathologically confirmed papillary breast lesions from January 2017 to June 2023. Preoperative sonographic examinations, including gray-scale ultrasound (G-US), color Doppler flow imaging (CDFI), and contrast-enhanced ultrasound (CEUS), were conducted. Sonographic scans were retrospectively reviewed alongside clinicopathological data. Binary logistic regression identified independent risk factors for screening atypical/malignant papillary lesions. The receiver operating characteristic curve evaluated the predictive accuracy of these lesions, resulting in the development of a nomogram for assessing risk. RESULTS The study involved 176 female patients with breast papillary lesions, identifying key predictors for atypical or malignant outcomes: age 57 or order, US diameter ≥13.95 mm, resistive index ≥0.70, enlarged enhancement on CEUS, and contrast agent retention, with respective odds ratios of 6.279, 8.078, 9.246, 9.401, and 5.047. The integrated use of G-US, CDFI, and CEUS in the MpUS approach offered higher diagnostic accuracy (area under the curve [AUC]: 0.966) than G-US or CDFI alone (0.869/0.918). CEUS particularly enhanced prediction for non-mass-like lesions, with a positive predictive value of 83.3%. A nomogram incorporating MpUS and patient age achieved an AUC of 0.956 for predicting atypical or malignant papillary lesions. CONCLUSIONS MpUS imaging is highly effective for predicting malignant breast papillary lesions, especially considering patient age. The nomogram offers an intuitive framework for assessing malignant risk in these lesions. ADVANCES IN KNOWLEDGE Ultrasound excels in identifying papillary lesions, and integrating diverse data and multi-parametric imaging enhances malignant risk evaluation. This study establishes a predictive risk model using the nomogram method, demonstrating heightened diagnostic efficacy in breast papillary lesions.
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Affiliation(s)
- Yunhua Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Hui Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Gang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Lifang Jin
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Hongmei Liang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, China
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Lei YM, Liu C, Hu HM, Li N, Zhang N, Wang Q, Zeng SE, Ye HR, Zhang G. Combined use of super-resolution ultrasound imaging and shear-wave elastography for differential diagnosis of breast masses. Front Oncol 2024; 14:1497140. [PMID: 39759128 PMCID: PMC11695221 DOI: 10.3389/fonc.2024.1497140] [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: 09/16/2024] [Accepted: 12/04/2024] [Indexed: 01/07/2025] Open
Abstract
Objectives Shear-wave elastography (SWE) provides valuable stiffness within breast masses, making it a useful supplement to conventional ultrasound imaging. Super-resolution ultrasound (SRUS) imaging enhances microvascular visualization, aiding in the differential diagnosis of breast masses. Current clinical ultrasound diagnosis of breast cancer primarily relies on gray-scale ultrasound. The combined diagnostic potential of tissue stiffness and microvascular characteristics, two critical tumor biomarkers, remains insufficiently explored. This study aims to evaluate the correlation between the elastic modulus, assessed using SWE, and microvascular characteristics captured through SRUS, in order to evaluate the effectiveness of combining these techniques in distinguishing between benign and malignant breast masses. Materials and methods In this single-center prospective study, 97 patients underwent SWE to obtain parameters including maximum elasticity (Emax), minimum elasticity (Emin), mean elasticity (Emean), standard deviation of elasticity (Esd), and elasticity ratio. SRUS was used to calculate the microvascular flow rate and microvessel density (MVD) within the breast masses. Spearman correlation analysis was used to explore correlations between Emax and MVD. Receiver operating characteristic curves and nomogram were employed to assess the diagnostic efficacy of combining SRUS with SWE, using pathological results as the gold standard. Results Emax, Emean, Esd, and MVD were significantly higher in malignant breast masses compared to benign ones (p < 0.001), while Emin was significantly lower in malignant masses (p < 0.05). In Spearman correlation analysis, Emax was significantly positively correlated with MVD (p < 0.01). The area under the curve for SRUS combined with SWE (0.924) was significantly higher than that for SWE (0.883) or SRUS (0.830) alone (p < 0.001), thus indicating improved diagnostic accuracy. The decision curve analysis of the nomogram indicated that SWE combined with SRUS model had a higher net benefit in predicting breast cancer. Conclusions The MVD of the breast mass shows a significant positive correlation with Emax. By integrating SRUS with SWE, this study proposes a novel diagnostic approach designed to improve specificity and accuracy in breast cancer detection, surpassing the limitations of current ultrasound-based methods. This approach shows promise for early breast cancer detection, with the potential to reduce the need for unnecessary biopsies and improve patient outcomes.
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Affiliation(s)
- Yu-Meng Lei
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Chen Liu
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
- Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Hai-Man Hu
- Department of Electrical and Electronic Engineering, Hubei University of Technology, Wuhan, China
| | - Nan Li
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Ning Zhang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Qi Wang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Shu-E Zeng
- Department of Medical Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Breast Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Breast Cancer, Wuhan Clinical Research Center for Breast Cancer, Wuhan, China
| | - Hua-Rong Ye
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Ge Zhang
- Department of Medical Ultrasound, China Resources & Wisco General Hospital, Wuhan University of Science and Technology, Wuhan, China
- Department of Cardiovascular Medicine, Wuhan Asia Heart Hospital, Wuhan, China
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Li X, Zhang L, Ding M. Ultrasound-based radiomics for the differential diagnosis of breast masses: A systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:778-788. [PMID: 38606802 DOI: 10.1002/jcu.23690] [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: 10/25/2023] [Revised: 02/19/2024] [Accepted: 04/01/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Ultrasound-based radiomics has demonstrated excellent diagnostic performance in differentiating benign and malignant breast masses. Given a few clinical studies on their diagnostic role, we conducted a meta-analysis of the potential effects of ultrasound-based radiomics for the differential diagnosis of breast masses, aiming to provide evidence-based medical basis for clinical research. MATERIALS AND METHODS We searched Embase, Web of Science, Cochrane Library, and PubMed databases from inception through to February 2023. The methodological quality assessment of the included studies was performed according to Quality Assessment of Diagnostic Accuracy Studies checklist. A diagnostic test accuracy systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Sensitivity, specificity, and area under curve delineating benign and malignant lesions were recorded. We also used sensitivity analysis and subgroup analysis to explore potential sources of heterogeneity. Deeks' funnel plots was used to examine the publication bias. RESULTS A total of 11 studies were included in this meta-analysis. For the diagnosis of malignant breast masses worldwide, the overall mean rates of sensitivity and specificity of ultrasound-based radiomics were 0.90 (95% confidence interval [CI], 0.83-0.95) and 0.89 (95% CI, 0.82-0.94), respectively. The summary diagnostic odds ratio was 76 (95% CI, 26-219), and the area under the curve for the summary receiver operating characteristic curve was 0.95 (95% CI, 0.93-0.97). CONCLUSION Ultrasound-based radiomics has the potential to improve diagnostic accuracy to discriminate between benign and malignant breast masses, and could reduce unnecessary biopsies.
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Affiliation(s)
- Xuerong Li
- Hebei North University, Zhangjiakou, Hebei, China
| | | | - Manni Ding
- The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
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Lee YJ, Kim SH, Kang BJ, Kim YJ. Contrast-enhanced ultrasound features as a potential biomarker for the prediction of breast cancer recurrence. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024. [PMID: 38802093 DOI: 10.1055/a-2333-7589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
PURPOSE To investigate the associations between contrast-enhanced ultrasound imaging features and disease recurrence among patients with locally advanced breast cancer treated with neoadjuvant chemotherapy. MATERIALS AND METHODS In the study, pre- and post-neoadjuvant chemotherapy contrast-enhanced ultrasound images of 43 patients with breast cancer were retrospectively analysed. Post-acquisition image processing involved the placement of freehand-drawn regions of interest, followed by the generation of blood flow kinetics representing blood volume and velocity for these regions of interest. Qualitative and quantitative contrast-enhanced ultrasound parameters were compared to predict recurrence, and receiver operating characteristic analysis was used to evaluate predictive ability. RESULTS Among the 43 patients, 10 (23%) exhibited disease recurrence (median [range]: 27 [4-68] months). Post-neoadjuvant chemotherapy peak enhancement, wash-in area under the curve, wash-out area under the curve, and wash-in and wash-out area under the curve (p=0.003, p=0.004, p=0.026, and p=0.014, respectively) differed between the no-recurrence and recurrence groups. The area under the receiver operating characteristic curve (0.88; 95% confidence interval: 0.75-1.00) for post-neoadjuvant chemotherapy peak enhancement was the highest among the contrast-enhanced ultrasound parameters, with a cut-off of 13.33 arbitrary units. CONCLUSION Higher peak enhancement on post-neoadjuvant chemotherapy contrast-enhanced ultrasound images was associated with recurrence in women with locally advanced breast cancer and is a potential biomarker of tumor recurrence.
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Affiliation(s)
- Youn Joo Lee
- Radiology (Daejeon St. Mary's Hospital), The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
| | - Sung Hun Kim
- Radiology (Seoul St. Mary's Hospital), The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
| | - Bong Joo Kang
- Radiology (Seoul St. Mary's Hospital), The Catholic University of Korea College of Medicine, Seoul, Korea (the Republic of)
| | - Yun Ju Kim
- Radiology, National Cancer Center, Goyang, Korea (the Republic of)
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Monzeglio O, Melissa VM, Rodolfi S, Valentini E, Carriero A. Exploring the potential of contrast agents in breast cancer echography: current state and future directions. J Ultrasound 2023; 26:749-756. [PMID: 37566194 PMCID: PMC10632334 DOI: 10.1007/s40477-023-00809-0] [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: 06/19/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023] Open
Abstract
Breast cancer stands as the most frequent malignancy and leading cause of death among women. Early and accurate detection of this pathology represents a crucial factor in enhancing both incidence and mortality rates. Ultrasound (US) examination has been extensively adopted in clinical practice due to its non-invasiveness, affordability, ease of implementation, and wide accessibility, thus representing a valuable first-line diagnostic tool for the study of the mammary gland. In this scenario, recent developments in nanomedicine are paving the way for new interpretations and applications of US diagnostics, which are becoming increasingly personalized based on the molecular phenotype of each tumor, allowing for more precise and accurate evaluations. This review highlights the current state-of-the-art of US diagnosis of breast cancer, as well as the recent advancements related to the application of US contrast agents to the field of molecular diagnostics, still under preclinical study.
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Affiliation(s)
- Oriana Monzeglio
- Department of Diagnosis and Treatment Services, Radiodiagnostics and Interventional Radiology, AOU Maggiore Della Carità, Corso Mazzini 18, 28100, Novara, Italy.
| | - Vittoria Maria Melissa
- Department of Diagnosis and Treatment Services, Radiodiagnostics and Interventional Radiology, AOU Maggiore Della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Sara Rodolfi
- Department of Diagnosis and Treatment Services, Radiodiagnostics and Interventional Radiology, AOU Maggiore Della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Eleonora Valentini
- Department of Diagnosis and Treatment Services, Radiodiagnostics and Interventional Radiology, AOU Maggiore Della Carità, Corso Mazzini 18, 28100, Novara, Italy
| | - Alessandro Carriero
- Department of Translation Medicine, University of Eastern Piemonte UPO, Via Solaroli 17, 28100, Novara, Italy
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Kondo S, Satoh M, Nishida M, Sakano R, Takagi K. Ceusia-Breast: computer-aided diagnosis with contrast enhanced ultrasound image analysis for breast lesions. BMC Med Imaging 2023; 23:114. [PMID: 37644398 PMCID: PMC10466705 DOI: 10.1186/s12880-023-01072-9] [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: 09/19/2022] [Accepted: 08/02/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND In recent years, contrast-enhanced ultrasonography (CEUS) has been used for various applications in breast diagnosis. The superiority of CEUS over conventional B-mode imaging in the ultrasound diagnosis of the breast lesions in clinical practice has been widely confirmed. On the other hand, there have been many proposals for computer-aided diagnosis of breast lesions on B-mode ultrasound images, but few for CEUS. We propose a semi-automatic classification method based on machine learning in CEUS of breast lesions. METHODS The proposed method extracts spatial and temporal features from CEUS videos and breast tumors are classified as benign or malignant using linear support vector machines (SVM) with combination of selected optimal features. In the proposed method, tumor regions are extracted using the guidance information specified by the examiners, then morphological and texture features of tumor regions obtained from B-mode and CEUS images and TIC features obtained from CEUS video are extracted. Then, our method uses SVM classifiers to classify breast tumors as benign or malignant. During SVM training, many features are prepared, and useful features are selected. We name our proposed method "Ceucia-Breast" (Contrast Enhanced UltraSound Image Analysis for BREAST lesions). RESULTS The experimental results on 119 subjects show that the area under the receiver operating curve, accuracy, precision, and recall are 0.893, 0.816, 0.841 and 0.920, respectively. The classification performance is improved by our method over conventional methods using only B-mode images. In addition, we confirm that the selected features are consistent with the CEUS guidelines for breast tumor diagnosis. Furthermore, we conduct an experiment on the operator dependency of specifying guidance information and find that the intra-operator and inter-operator kappa coefficients are 1.0 and 0.798, respectively. CONCLUSION The experimental results show a significant improvement in classification performance compared to conventional classification methods using only B-mode images. We also confirm that the selected features are related to the findings that are considered important in clinical practice. Furthermore, we verify the intra- and inter-examiner correlation in the guidance input for region extraction and confirm that both correlations are in strong agreement.
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Weng H, Zhao Y, Xu Y, Hong Y, Wang K, Huang P. A Diagnostic Model for Breast Lesions With Enlarged Enhancement Extent on Contrast-Enhanced Ultrasound Improves Malignancy Prediction. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1535-1543. [PMID: 37012097 DOI: 10.1016/j.ultrasmedbio.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE The aim of the work described here was to develop a diagnostic model based on contrast-enhanced ultrasound (CEUS) features to improve performance in predicting the probability of malignancy for breast lesions with an enlarged enhancement extent on CEUS. METHODS In total, 299 consecutive patients who underwent CEUS examination and had confirmed pathological results were retrospectively enrolled. Among the 299 patients, an enlarged enhancement extent on CEUS was found in 142 patients. In this special cohort, we analyzed the association of malignant pathologic results with perfusion patterns emphatically by reclassifying the patterns. RESULTS A diagnostic model was developed and presented as a nomogram, assessed with discrimination and calibration. Receiver operating characteristic (ROC) curve analysis revealed that the areas under the curves of the conventional perfusion and modified perfusion patterns were 0.58 and 0.76 (p < 0.001), respectively. A diagnostic model was built and exhibited good discrimination with a C-index of 0.95 (95% confidence interval: 0.91-0.98), which was confirmed to be 0.93 via internal bootstrapping validation. CONCLUSION The nomogram based on CEUS features provides radiologists with a quantitative tool to predict the probability of malignancy in this special cohort of breast lesions.
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Affiliation(s)
- Huifang Weng
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanan Zhao
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yongyuan Xu
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yurong Hong
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ke Wang
- Department of Breast Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Research Center for Life Science and Human Health, Binjiang Institute of Zhejiang University, Hangzhou, China.
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Sinagra L, Orlandi R, Caspanello T, Troisi A, Iannelli NM, Vallesi E, Pettina G, Bargellini P, De Majo M, Boiti C, Cristarella S, Quartuccio M, Polisca A. Contrast-Enhanced Ultrasonography (CEUS) in Imaging of the Reproductive System in Dogs: A Literature Review. Animals (Basel) 2023; 13:ani13101615. [PMID: 37238045 DOI: 10.3390/ani13101615] [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] [Received: 03/15/2023] [Revised: 04/26/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
The use of contrast-enhanced ultrasound (CEUS) has been widely reported for reproductive imaging in humans and animals. This review aims to analyze the utility of CEUS in characterizing canine reproductive physiology and pathologies. In September 2022, a search for articles about CEUS in canine testicles, prostate, uterus, placenta, and mammary glands was conducted on PubMed and Scopus from 1990 to 2022, showing 36 total results. CEUS differentiated testicular abnormalities and neoplastic lesions, but it could not characterize tumors. In prostatic diseases, CEUS in dogs was widely studied in animal models for prostatic cancer treatment. In veterinary medicine, this diagnostic tool could distinguish prostatic adenocarcinomas. In ovaries, CEUS differentiated the follicular phases. In CEH-pyometra syndrome, it showed a different enhancement between endometrium and cysts, and highlighted angiogenesis. CEUS was shown to be safe in pregnant dogs and was able to assess normal and abnormal fetal-maternal blood flow and placental dysfunction. In normal mammary glands, CEUS showed vascularization only in diestrus, with differences between mammary glands. CEUS was not specific for neoplastic versus non-neoplastic masses and for benign tumors, except for complex carcinomas and neoplastic vascularization. Works on CEUS showed its usefulness in a wide spectrum of pathologies of this non-invasive, reliable diagnostic procedure.
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Affiliation(s)
- Letizia Sinagra
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Riccardo Orlandi
- Anicura Tyrus Clinica Veterinaria, Via Bartocci 1G, 05100 Terni, Italy
| | - Tiziana Caspanello
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Alessandro Troisi
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Macerata, Italy
| | - Nicola Maria Iannelli
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
- Clinica Veterinaria Camagna-VetPartners, Via Fortunato Licandro 13, 89124 Reggio di Calabria, Italy
| | - Emanuela Vallesi
- Anicura Tyrus Clinica Veterinaria, Via Bartocci 1G, 05100 Terni, Italy
- Anicura CMV Clinica Veterinaria, Via G.B. Aguggiari 162, 21100 Varese, Italy
| | - Giorgia Pettina
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Paolo Bargellini
- Anicura Tyrus Clinica Veterinaria, Via Bartocci 1G, 05100 Terni, Italy
| | - Massimo De Majo
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Cristiano Boiti
- Tyrus Science Foundation, Via Bartocci 1G, 05100 Terni, Italy
| | - Santo Cristarella
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Marco Quartuccio
- Department of Veterinary Sciences, University of Messina, Viale Palatucci, 13, 98168 Messina, Italy
| | - Angela Polisca
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy
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Han MR, Park AY, Seo BK, Bae MS, Kim JS, Son GS, Lee HY, Chang YW, Cho KR, Song SE, Woo OH, Ju HY, Oh H. Association between vascular ultrasound features and DNA sequencing in breast cancer: a preliminary study. Discov Oncol 2023; 14:52. [PMID: 37120792 PMCID: PMC10149538 DOI: 10.1007/s12672-023-00657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/14/2023] [Indexed: 05/01/2023] Open
Abstract
There are few radiogenomic studies to correlate ultrasound features of breast cancer with genomic changes. We investigated whether vascular ultrasound phenotypes are associated with breast cancer gene profiles for predicting angiogenesis and prognosis. We prospectively correlated quantitative and qualitative features of microvascular ultrasound (vascular index, vessel morphology, distribution, and penetrating vessel) and contrast-enhanced ultrasound (time-intensity curve parameters and enhancement pattern) with genomic characteristics in 31 breast cancers. DNA obtained from breast tumors and normal tissues were analyzed using targeted next-generation sequencing of 105 genes. The single-variant association test was used to identify correlations between vascular ultrasound features and genomic profiles. Chi-square analysis was used to detect single nucleotide polymorphisms (SNPs) associated with ultrasound features by estimating p values and odds ratios (ORs). Eight ultrasound features were significantly associated with 9 SNPs (p < 0.05). Among them, four ultrasound features were positively associated with 5 SNPs: high vascular index with rs1136201 in ERBB2 (p = 0.04, OR = 7.75); large area under the curve on contrast-enhanced ultrasound with rs35597368 in PDGFRA (p = 0.04, OR = 4.07); high peak intensity with rs35597368 in PDGFRA (p = 0.049, OR = 4.05) and rs2305948 in KDR (p = 0.04, OR = 5.10); and long mean transit time with rs2275237 in ARNT (p = 0.02, OR = 10.25) and rs755793 in FGFR2 (p = 0.02, OR = 10.25). We identified 198 non-silent SNPs in 71 various cancer-related genes. Vascular ultrasound features can reflect genomic changes associated with angiogenesis and prognosis in breast cancer.
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Affiliation(s)
- Mi-Ryung Han
- Division of Life Sciences, College of Life Sciences and Bioengineering, Incheon National University, Incheon, Republic of Korea
| | - Ah Young Park
- Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do 15355 Republic of Korea
| | - Min Sun Bae
- Department of Radiology, Inha University Hospital and College of Medicine, Inhang-ro 27, Jung-gu, Incheon, 22332 Republic of Korea
| | - Jung Sun Kim
- Division of Hematology/Oncology, Department of Internal medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Gyeonggi-do Republic of Korea
| | - Gil Soo Son
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Gyeonggi-do Republic of Korea
| | - Hye Yoon Lee
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Gyeonggi-do Republic of Korea
| | - Young Woo Chang
- Division of Breast and Endocrine Surgery, Department of Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Gyeonggi-do Republic of Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hye-Yeon Ju
- Division of Life Sciences, College of Life Sciences and Bioengineering, Incheon National University, Incheon, Republic of Korea
| | - Hyunseung Oh
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Gyeonggi-do Republic of Korea
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11
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Wang B, Yang D, Zhang X, Gong X, Xu T, Han J, Ren Y, Zou S, Li L, Wang Y. The diagnostic value of contrast-enhanced ultrasonography in breast ductal abnormalities. Cancer Imaging 2023; 23:25. [PMID: 36899406 PMCID: PMC10007791 DOI: 10.1186/s40644-023-00539-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 02/25/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Ductal lesions are an important, often overlooked, and poorly understood issue in breast imaging, which have a risk of underlying malignancy ranging from 5 to 23%. Ultrasonography (US), which has largely replaced galactography or ductography, has become an important imaging method to assess patients with ductal lesions. However, it is difficult to distinguish benign from malignant ductal abnormalities only by ultrasonography, most of which are recommended to be at least in subcategory 4A; these require biopsy according to the ACR BI-RADS®atlas 5th Edition-breast ultrasound. Contrast-enhanced ultrasound (CEUS) has been shown to be valuable for differentiating benign from malignant tumors, but its value is unclear in breast ductal lesions. Therefore, the purposes of this study were to explore the characteristics of malignant ductal abnormalities on US and CEUS imaging and the diagnostic value of CEUS in breast ductal abnormalities. METHODS Overall, 82 patients with 82 suspicious ductal lesions were recruited for this prospective study. They were divided into benign and malignant groups according to the pathological results. Morphologic features and quantitative parameters of US and CEUS were analyzed by comparison and multivariate logistic regression to determine the independent risk factors. The diagnostic performance was assessed by receiver operating characteristic (ROC) curve analysis. RESULTS Shape, margin, inner echo, size, microcalcification and blood flow classification on US, wash-in time, enhancement intensity, enhancement mode, enhancement scope, blood perfusion defects, peripheral high enhancement and boundary on CEUS were identified as features correlated with malignant ductal lesions. However, multivariate logistic regression showed that only microcalcification (OR = 8.96, P = 0.047) and enhancement scope (enlarged, OR = 27.42, P = 0.018) were independent risk factors for predicting malignant ductal lesions. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and area under the ROC curve of microcalcifications combined with an enlarged enhancement scope were 0.895, 0.886, 0.872, 0.907, 0.890, and 0.92, respectively. CONCLUSIONS Microcalcification and enlarged enhancement scope are independent factors for predicting malignant ductal lesions. The combined diagnosis can greatly improve the diagnostic performance, indicating that CEUS can be useful in the differentiation of benign and malignant lesions to formulate more appropriate management for ductal lesions.
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Affiliation(s)
- Bo Wang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Di Yang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuan Zhang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - XuanTong Gong
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tong Xu
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jie Han
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - YinPeng Ren
- Department of Breast Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - ShuangMei Zou
- Department of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Li
- Department of Radiology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Yong Wang
- Department of Ultrasound, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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12
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Diagnostic Value of Multi-Mode Ultrasonic Flow Imaging Examination in Solid Renal Tumors of Different Sizes. J Clin Med 2023; 12:jcm12020566. [PMID: 36675494 PMCID: PMC9860825 DOI: 10.3390/jcm12020566] [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: 11/16/2022] [Revised: 12/19/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Purposes: To explore the value of Microflow Imaging (MFI) in renal solid tumors. Methods: A total of 195 patients with 199 lesions pathologically confirmed masses were retrospectively analyzed. The 199 masses were divided into the tumor ≤ 4 cm group (n = 104) and tumor > 4 cm group (n = 95). The diagnostic efficacy of Color Doppler Flow Imaging (CDFI), Power Doppler Imaging (PDI) and MFI in renal tumors sizes were compared by determining the Adler grade, vascular morphology and peripheral blood flow. Results: Among 199 tumors, 161 lesions were malignant and 38 lesions were benign. MFI in malignant tumor ≤ 4 cm demonstrated statistically significant differences in Adler grade and vascular morphology as compared to CDFI and PDI (p < 0.05). In malignant tumor > 4 cm group, MFI showed significant difference in vascular morphology compared with CDFI (p < 0.05). MFI showed a significant difference in the peripheral annular blood flow of malignant tumors when compared to CDFI and PDI (p < 0.05). In addition, the malignant tumors of the two sizes by MFI in peripheral annular blood flow detection showed significant difference (p < 0.05). The area under the curve of ROC by MFI in the tumor ≤ 4 cm was 0.771, which was higher than CDFI and PDI (p < 0.05), but no obvious difference among the tumor > 4 cm (p > 0.05). Conclusion: MFI provides a new method for the differential diagnosis of small renal carcinoma. Based on the convenience and non-radiation of MFI, we can choose MFI as an imaging diagnostic tool for patients who need long-term active surveillance (AS) follow-up.
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13
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Chen Y, Lu J, Li J, Liao J, Huang X, Zhang B. Evaluation of diagnostic efficacy of multimode ultrasound in BI-RADS 4 breast neoplasms and establishment of a predictive model. Front Oncol 2022; 12:1053280. [PMID: 36505867 PMCID: PMC9730703 DOI: 10.3389/fonc.2022.1053280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives To explore the diagnostic efficacy of ultrasound (US), two-dimensional and three-dimensional shear-wave elastography (2D-SWE and 3D-SWE), and contrast-enhanced ultrasound (CEUS) in breast neoplasms in category 4 based on the Breast Imaging Reporting and Data System (BI-RADS) from the American College of Radiology (ACR) and to develop a risk-prediction nomogram based on the optimal combination to provide a reference for the clinical management of BI-RADS 4 breast neoplasms. Methods From September 2021 to April 2022, a total of 104 breast neoplasms categorized as BI-RADS 4 by US were included in this prospective study. There were 78 breast neoplasms randomly assigned to the training cohort; the area under the receiver-operating characteristic curve (AUC), 95% confidence interval (95% CI), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 2D-SWE, 3D-SWE, CEUS, and their combination were analyzed and compared. The optimal combination was selected to develop a risk-prediction nomogram. The performance of the nomogram was assessed by a validation cohort of 26 neoplasms. Results Of the 78 neoplasms in the training cohort, 16 were malignant and 62 were benign. Among the 26 neoplasms in the validation cohort, 6 were malignant and 20 were benign. The AUC values of 2D-SWE, 3D-SWE, and CEUS were not significantly different. After a comparison of the different combinations, 2D-SWE+CEUS showed the optimal performance. Least absolute shrinkage and selection operator (LASSO) regression was used to filter the variables in this combination, and the variables included Emax, Eratio, enhancement mode, perfusion defect, and area ratio. Then, a risk-prediction nomogram with BI-RADS was built. The performance of the nomogram was better than that of the radiologists in the training cohort (AUC: 0.974 vs. 0.863). In the validation cohort, there was no significant difference in diagnostic accuracy between the nomogram and the experienced radiologists (AUC: 0.946 vs. 0.842). Conclusions US, 2D-SWE, 3D-SWE, CEUS, and their combination could improve the diagnostic efficiency of BI-RADS 4 breast neoplasms. The diagnostic efficacy of US+3D-SWE was not better than US+2D-SWE. US+2D-SWE+CEUS showed the optimal diagnostic performance. The nomogram based on US+2D-SWE+CEUS performs well.
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14
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Tang K, Liu M, Zhu Y, Zhang M, Niu C. The clinical application of ultrasonography with superb microvascular imaging-a review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:721-732. [PMID: 35358353 DOI: 10.1002/jcu.23210] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/19/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Superb microvascular imaging (SMI) is among the latest doppler ultrasound methods. It uses an advanced clutter filter to eliminate artifacts caused by breathing, movement and retains the low-speed blood signals in microvessels. The great advantage of SMI is that it can intuitively detect very slow blood signals in microvessels, providing clinicians with more significant information about flow distribution in the target area. Therefore, it is speculated that SMI has important application value. The purpose of this article is to outline the application of SMI in different parts of the body.
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Affiliation(s)
- Kui Tang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Minghui Liu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yun Zhu
- Department of Ultrasound Imaging, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Ming Zhang
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chengcheng Niu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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15
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Lin J, Lin W, Xu L, Lin T. Diagnostic value of various vascular features of breast cancer by age. Clin Hemorheol Microcirc 2022; 80:317-325. [PMID: 34719486 DOI: 10.3233/ch-211258] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tumor angiogenesis plays a critical role in the growth and metastasis of breast cancer. Evaluating the added value of vascular features to Breast Imaging Reporting and Data System (BI-RADS) in differentiating malignant masses from benign ones is essential. Micro-flow Imaging (MFI) is a promising noninvasive diagnostic method for the microvessels in breast tumors, but its precise value is still uncertain. OBJECTIVES Understanding whether malignant tumor vascular characteristics by MFI are associated with breast cancer and whether the diagnostic efficiency varies by age. MATERIALS AND METHODS B-mode ultrasound and MFI were performed for 153 solid breast lesions. The vessels images by MFI were reviewed and assessed by two investigators, respectively. Then the diagnostic efficacy of different vascular features combined with BI-RADS was evaluated in different age groups. RESULTS The mean size of lesions is 19.4 (range 18-78) mm. There were 94 breast masses in benign, while 59 breast masses in malignant by pathology. III Adler classification, penetrating vessels, and complex flow pattern showed a positive association with a high risk of malignant breast lesions (p < 0.05). BI-RADS combined with vessel characteristics show better improvement of diagnostic performance of breast lesions in the elderly group than in the young group. CONCLUSIONS Vascular features by MFI contribute to malignant breast masses' diagnosis, and the association might be modified by age.
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Affiliation(s)
- Jia Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou Unviersity Medical College, Shantou, Guangdong, China
| | - Wenqiang Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou Unviersity Medical College, Shantou, Guangdong, China
| | - Liang Xu
- Shantou University Medical College, Shantou, Guangdong, China
| | - Teng Lin
- Department of Ultrasound, First Affiliated Hospital, Shantou Unviersity Medical College, Shantou, Guangdong, China
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16
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Lin ZM, Chen JF, Xu FT, Liu CM, Chen JS, Wang Y, Zhang C, Huang PT. Principal component regression-based contrast-enhanced ultrasound evaluation system for the management of BI-RADS US 4A breast masses: objective assistance for radiologists. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1737-1746. [PMID: 33838937 DOI: 10.1016/j.ultrasmedbio.2021.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
A portion of detected breast masses might be overrated by using the Breast Imaging-Reporting and Data System ultrasonography (BI-RADS US) lexicon. A principal component regression-based contrast-enhanced ultrasound (PCR-CEUS) evaluation system was built to quantitatively illustrate whether CEUS could help radiologists to differentiate 4A masses. The PCR-CEUS evaluation system, based on principal component analysis (PCA) and logistic regression, was verified by random assignment into training and test sets and shown to reduce the data dimension and avoid collinearity in CEUS variables. This prospective study consecutively collected 238 patients with 238 4A masses confirmed pathologically. All enrolled patients accepted CEUS examination. The diagnostic performance of senior and junior radiologists, PCR-CEUS and combined methods was compared. The PCR-CEUS system had consistent diagnostic performance in both the training and test sets, with an area under the curve (AUC) of 0.831 (0.765-0.897), 0.798 (0.7034-0.892) and 0.854 (0.765-0.943) (all P > 0.05). The AUC of the combined diagnostic model (PCR-CEUS + Senior radiologists) was higher than that of senior radiologists, and the combined model had higher sensitivity (0.875 (0.781-0.969) vs. 0.729 (0.603-0.855)) without compromising specificity. Furthermore, the AUC and specificity of the combined model (PCR-CEUS + Junior radiologists) (0.852 (0.787-0.916)) was higher than that of junior radiologists (0.665 (0.592-0.737) (P < 0.00001)). PCR-CEUS demonstrated good ability in differentiating malignant BI-RADS-US 4A masses and was helpful for both senior and junior radiologists.
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Affiliation(s)
- Zi-Mei Lin
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Ji-Fan Chen
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Fang-Ting Xu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Chun-Mei Liu
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Jian-She Chen
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yao Wang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Chao Zhang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Pin-Tong Huang
- Department of Ultrasound in Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China; Research Center of Ultrasound in Medicine and Biomedical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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17
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Huang Y, Le J, Miao A, Zhi W, Wang F, Chen Y, Zhou S, Chang C. Prediction of treatment responses to neoadjuvant chemotherapy in breast cancer using contrast-enhanced ultrasound. Gland Surg 2021; 10:1280-1290. [PMID: 33968680 DOI: 10.21037/gs-20-836] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Elucidation the efficacy of neoadjuvant chemotherapy (NAC) in breast cancer is important for informing therapeutic decisions. This study aimed at evaluating the potential value of contrast-enhanced ultrasound (CEUS) parameters in predicting breast cancer responses to NAC. Methods We performed CEUS examinations before and after two cycles of NAC. Quantitative CEUS parameters [maximum intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (mTT)], tumor diameter, and their changes were measured and compared to histopathological responses, according to the Miller-Payne Grading (MPG) system (score 1, 2, or 3: minor response; score 4 or 5: good response). Prediction models for good response were developed by multiple logistic regression analysis and internally validated through bootstrap analysis. The receiver operating characteristic (ROC) curve was used to evaluate the performance of prediction models. Results A total of 143 patients were enrolled in this study among whom 98 (68.5%) achieved a good response and while 45 (31.5%) exhibited a minor response. Several imaging variables including diameter, IMAX, changes in diameter (Δdiameter), IMAX (ΔIMAX) and TTP (ΔTTP) were found to be significantly associated with good therapeutic responses (P<0.05). The areas under the curve (AUC) increased from 0.748 to 0.841 in the multivariate model that combined CEUS parameters and molecular subtypes with a sensitivity and specificity of 0.786, 0.745, respectively. Tumor molecular subtype was the primary predictor of primary endpoint. Conclusions CEUS is a potential tool for predicting responses to NAC in locally advanced breast cancer patients. Compared to the other molecular subtypes, triple negative and HER2+/ER- subtypes are more likely to exhibit a good response to NAC.
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Affiliation(s)
- Yunxia Huang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jian Le
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Aiyu Miao
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenxiang Zhi
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fen Wang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yaling Chen
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shichong Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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18
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Boca (Bene) I, Dudea SM, Ciurea AI. Contrast-Enhanced Ultrasonography in the Diagnosis and Treatment Modulation of Breast Cancer. J Pers Med 2021; 11:jpm11020081. [PMID: 33573122 PMCID: PMC7912589 DOI: 10.3390/jpm11020081] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/23/2021] [Accepted: 01/28/2021] [Indexed: 12/22/2022] Open
Abstract
The aim of this paper is to highlight the role of contrast-enhanced ultrasound in breast cancer in terms of diagnosis, staging and follow-up of the post-treatment response. Contrast-enhanced ultrasound (CEUS) is successfully used to diagnose multiple pathologies and has also clinical relevance in breast cancer. CEUS has high accuracy in differentiating benign from malignant lesions by analyzing the enhancement characteristics and calculating the time-intensity curve’s quantitative parameters. It also has a significant role in axillary staging, especially when the lymph nodes are not suspicious on clinical examination and have a normal appearance on gray-scale ultrasound. The most significant clinical impact consists of predicting the response to neoadjuvant chemotherapy, which offers the possibility of adjusting the therapy by dynamically evaluating the patient. CEUS is a high-performance, feasible, non-irradiating, accessible, easy-to-implement imaging method and has proven to be a valuable addition to breast ultrasound.
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19
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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: 22] [Impact Index Per Article: 5.5] [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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20
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Mantella LE, Liblik K, Johri AM. Vascular imaging of atherosclerosis: Strengths and weaknesses. Atherosclerosis 2021; 319:42-50. [PMID: 33476943 DOI: 10.1016/j.atherosclerosis.2020.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022]
Abstract
Atherosclerosis is an inflammatory disease that can lead to several complications such as ischemic heart disease, stroke, and peripheral vascular disease. Therefore, researchers and clinicians rely heavily on the use of imaging modalities to identify, and more recently, quantify the burden of atherosclerosis in the aorta, carotid arteries, coronary arteries, and peripheral vasculature. These imaging techniques vary in invasiveness, cost, resolution, radiation exposure, and presence of artifacts. Consequently, a detailed understanding of the risks and benefits of each technique is crucial prior to their introduction into routine cardiovascular screening. Additionally, recent research in the field of microvascular imaging has proven to be important in the field of atherosclerosis. Using techniques such as contrast-enhanced ultrasound and superb microvascular imaging, researchers have been able to detect blood vessels within a plaque lesion that may contribute to vulnerability and rupture. This paper will review the strengths and weaknesses of the various imaging techniques used to measure atherosclerotic burden. Furthermore, it will discuss the future of advanced imaging modalities as potential biomarkers for atherosclerosis.
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Affiliation(s)
- Laura E Mantella
- Department of Biomedical and Molecular Sciences, Queen's University, 18 Stuart Street, K7L 3N6, Kingston, ON, Canada
| | - Kiera Liblik
- Department of Medicine, Cardiovascular Imaging Network at Queen's University, 76 Stuart Street, K7L 2V7, Kingston, ON, Canada
| | - Amer M Johri
- Department of Biomedical and Molecular Sciences, Queen's University, 18 Stuart Street, K7L 3N6, Kingston, ON, Canada; Department of Medicine, Cardiovascular Imaging Network at Queen's University, 76 Stuart Street, K7L 2V7, Kingston, ON, Canada.
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21
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Pan J, Tong W, Luo J, Liang J, Pan F, Zheng Y, Xie X. Does contrast-enhanced ultrasound (CEUS) play a better role in diagnosis of breast lesions with calcification? A comparison with MRI. Br J Radiol 2020; 93:20200195. [PMID: 32463295 DOI: 10.1259/bjr.20200195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare the efficacy of contrast-enhanced ultrasound enabled reclassification of Breast Imaging Reporting and Data System (CEUS-BI-RADS) with MRI in the diagnosis of breast lesions with calcification. METHODS A total of 52 breast lesions with calcification from 51 patients were detected by ultrasound as hyperechoic foci and categorized as BI-RADS 3-5. The 51 patients further underwent CEUS scan and MRI. The ultrasound-BI-RADS combined with CEUS 5-point score system redefined the classification of BI-RADS which was called CEUS-BI-RADS. The diagnostic efficacy of three methods was assessed by receiver operating characteristic (ROC) curve analysis. Histopathological assessment used as the gold-standard. RESULTS The sensitivities of Ultrasound-BI-RADS, MRI classification of BI-RADS (MRI-BI-RADS) and CEUS-BI-RADS were 85%, 90% and 95% without significant difference among the three modalities (p > 0.05). The diagnostic specificities of ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS were 78.1%, 78.1% and 96.8%, respectively (p < 0.05); and the accuracy were 80.7%, 82.6% and 96.1% for ultrasound-BI-RADS, MRI-BI-RADS and CEUS-BI-RADS, respectively (p < 0.05). The area under ROC (AUROC) in differentiation of breast lesions with calcification was 0.945 for CEUS-BI-RADS, 0.907 for MRI-BI-RADS and 0.853 for ultrasound-BI-RADS, with no significant difference among the three modalities (p > 0.05). CONCLUSION The CEUS-BI-RADS has a better diagnostic efficiency than MRI-BI-RADS in the differentiation of the breast lesions with calcification. ADVANCES IN KNOWLEDGE •CEUS is a better method in differentiation of breast lesions with calcification.•CEUS-BI-RADS increases the efficiency of diagnosis compared to MRI.
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Affiliation(s)
- Jiamin Pan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Wenjuan Tong
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Jia Luo
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Jinyu Liang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Fushun Pan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yanling Zheng
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
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22
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Park AY, Kwon M, Woo OH, Cho KR, Park EK, Cha SH, Song SE, Lee JH, Cha J, Son GS, Seo BK. 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. Korean J Radiol 2020; 20:759-772. [PMID: 30993927 PMCID: PMC6470080 DOI: 10.3348/kjr.2018.0515] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/22/2018] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.,Department of Radiology, Bundang CHA Medical Center, CHA University, Seongnam, Korea
| | - Myoungae Kwon
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ok Hee Woo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Kyung Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ju Han Lee
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - JaeHyung Cha
- Medical Science Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Gil Soo Son
- Division of Breast Endocrine Surgery, Department of General Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
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23
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Zhang XY, Zhang L, Li N, Zhu QL, Li JC, Sun Q, Wang HY, Jiang YX. Vascular index measured by smart 3-D superb microvascular imaging can help to differentiate malignant and benign breast lesion. Cancer Manag Res 2019; 11:5481-5487. [PMID: 31354354 PMCID: PMC6580120 DOI: 10.2147/cmar.s203376] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/14/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose: The purpose of our study was to prospectively evaluate the diagnostic performance of the vascular index (VI, defined as the ratio of Doppler signal pixels to pixels in the total lesion) measured via Smart 3-D superb microvascular imaging (SMI) for breast lesions. Patients and methods: Two hundred and thirty-two consecutive patients with 236 breast lesions referred for biopsy at Peking Union Medical College Hospital were enrolled in the study from December 2016 to November 2017. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of VI were calculated with histopathologic results as the reference standard. Results: Of the 236 breast lesions, 121 were malignant and 115 were benign. The mean VI was significantly higher in malignant lesions (9.7±8.2) than that in benign ones (3.4±3.3) (P<0.0001). Sensitivity, specificity, PPV, NPV and accuracy of VI (4.0 as the threshold) were respectively: 76.0%, 66.1%, 70.2%, 72.4% and 71.2% (P<0.05). Conclusion: Smart three-dimensional (3-D) SMI is a noninvasive tool using two-dimensional (2-D) scanning to generate 3-D vascular architecture with a high-resolution image of micro-vessels. This can be used as a qualitative guide to identify the optimal 2-D SMI plane with the most abundant vasculature to guide VI quantitative measurements of breast lesions. Smart 3-D SMI may potentially serve as a noninvasive tool to accurately characterize benign versus malignant breast lesions.
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Affiliation(s)
- Xiao-Yan Zhang
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Li Zhang
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Na Li
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Qing-Li Zhu
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Jian-Chu Li
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Qiang Sun
- Department of Breast Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Hong-Yan Wang
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Yu-Xin Jiang
- Department of Diagnostic Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
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24
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Zhao C, Xiao M, Jiang Y, Liu H, Wang M, Wang H, Sun Q, Zhu Q. Feasibility of computer-assisted diagnosis for breast ultrasound: the results of the diagnostic performance of S-detect from a single center in China. Cancer Manag Res 2019; 11:921-930. [PMID: 30774422 PMCID: PMC6350640 DOI: 10.2147/cmar.s190966] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the feasibility of a CAD system S-detect on a database from a single Chinese medical center. Materials and methods An experienced radiologist performed breast US examinations and made assessments of 266 consecutive breast lesions in 227 patients. S-detect classified the lesions automatically in a dichotomous form. An in-training resident who was blind to both the US diagnostic results and histological results reviewed the images afterward. The final histological results were considered as the diagnostic gold standard. The diagnostic performances and interrater agreements were analyzed. Results A total of 266 focal breast lesions (161 benign lesions and 105 malignant lesions) were assessed in this study. S-detect had a lower sensitivity (87.07%) and a higher specificity (72.27%) compared with the experienced radiologist (sensitivity 98.1% and specificity 65.43%). The sensitivity and specificity of S-detect were better than that of the resident (sensitivity 82.86% and specificity 68.94%). The AUC value of S-detect (0.807) showed no significant difference with the experienced radiologist (0.817) and was higher than that of the resident (0.758). S-detect had moderate agreement with the experienced radiologist. Conclusion In this single-center study, a high level of diagnostic performance of S-detect on 266 breast lesions of Chinese women was observed. S-detect had almost equal diagnostic capacity with an experienced radiologist and performed better than a novice reader. S-detect was also distinguished for its high specificity. These results supported the feasibility of S-detect in aiding the diagnosis of breast lesions on an independent database.
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Affiliation(s)
- Chenyang Zhao
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China,
| | - Mengsu Xiao
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China,
| | - Yuxin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China,
| | - He Liu
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China,
| | - Ming Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China,
| | - Hongyan Wang
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China,
| | - Qiang Sun
- Department of Breast Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China
| | - Qingli Zhu
- Department of Ultrasound, Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Beijing 100730, China,
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25
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Zhan J, Ding H. Application of contrast-enhanced ultrasound for evaluation of thyroid nodules. Ultrasonography 2018; 37:288-297. [PMID: 30213158 PMCID: PMC6177690 DOI: 10.14366/usg.18019] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/03/2018] [Indexed: 12/14/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is widely used to evaluate tumor microcirculation, which is useful in the differential diagnosis between benignity and malignancy. In the last 10 years, the applicability of CEUS to thyroid nodules has greatly improved due to technological refinements and the development of second-generation contrast agents. In this review, we summarize the applications of CEUS for thyroid nodules, focusing on the imaging findings of malignant and benign nodules in the existing literature and the use of those findings to predict malignancies, with an additional brief description of the utilization of CEUS for other thyroid-related diseases.
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Affiliation(s)
- Jia Zhan
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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26
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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: 4.0] [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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27
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He MN, Lv K, Jiang YX, Jiang TA. Application of superb microvascular imaging in focal liver lesions. World J Gastroenterol 2017; 23:7765-7775. [PMID: 29209117 PMCID: PMC5703936 DOI: 10.3748/wjg.v23.i43.7765] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/14/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To explore the ability of superb microvascular imaging (SMI) in differential diagnosis of focal liver lesions (FLLs) and to compare SMI morphology findings to those of color Doppler ultrasound and enhanced imaging.
METHODS Twenty-four patients with 31 FLLs were included in our study, with diagnoses of hemangioma (HE) (n = 17), hepatocellular carcinoma (HCC) (n = 5), metastatic lesions (n = 5), primary hepatic lymphoma (n = 1), focal nodular hyperplasia (FNH) (n = 2), and adenoma (n = 1). Nine lesions were pathologically diagnosed, and 22 lesions were radiologically confirmed, all of which were evaluated by at least two types of enhanced imaging techniques. All patients had undergone SMI. Patients were divided into subgroups based on pathological and radiological diagnoses to analyze SMI manifestations. We also compared the SMI manifestations of the most common malignant FLLs (HCCs and metastatic lesions) with those of the most common benign FLLs (HEs).
RESULTS HEs were classified into three SMI subgroups: diffuse dot-like type (n = 6), strip rim type (n = 8), and nodular rim type (n = 3). The sizes of the three types of HEs were significantly different (P = 0.00, < 0.05). HCCs were classified into two subgroups: diffuse honeycomb type (n = 2) and non-specific type (n = 3). Four of the metastatic lesions were the strip rim type, and the other metastatic lesion was the thick rim type, which is the same as that of lymphoma. FNH was described as a spoke-wheel type, and adenoma as a diffuse honeycomb type. The SMI types of HCCs and metastatic lesions were significantly different from those of HEs (P = 0.048, < 0.05).
CONCLUSION SMI technology enables microvascular evaluation of FLLs without using any contrast agent. For HEs, lesion size may affect SMI performance. SMI is able to provide useful information for differential diagnosis of HCCs and metastatic lesions from HEs.
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Affiliation(s)
- Meng-Na He
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ke Lv
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yu-Xin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Tian-An Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
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28
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Park AY, Seo BK. Up-to-date Doppler techniques for breast tumor vascularity: superb microvascular imaging and contrast-enhanced ultrasound. Ultrasonography 2017; 37:98-106. [PMID: 29025210 PMCID: PMC5885476 DOI: 10.14366/usg.17043] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/09/2017] [Accepted: 08/19/2017] [Indexed: 12/21/2022] Open
Abstract
Ultrasonographic Doppler techniques have improved greatly over the years, allowing more sophisticated evaluation of breast tumor vascularity. Superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) with second-generation contrast agents are two representative up-to-date techniques. SMI is a sensitive Doppler technique that adopts an intelligent filter system to separate low-flow signals from artifacts. With the development of second-generation contrast agents, CEUS has also emerged as a useful Doppler technique for evaluating tumor microcirculation. Both techniques can improve the diagnostic performance of gray-scale ultrasonography by providing vascular information useful not only for the morphologic assessment of microvessels, but also for the quantitative analysis of perfusion. In this review, we explain the imaging principles and previous research underlying these two vascular techniques, and describe our clinical experiences.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.,Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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29
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Faustino-Rocha AI, Gama A, Oliveira PA, Vanderperren K, Saunders JH, Pires MJ, Ferreira R, Ginja M. Modulation of mammary tumor vascularization by mast cells: Ultrasonographic and histopathological approaches. Life Sci 2017; 176:35-41. [PMID: 28336398 DOI: 10.1016/j.lfs.2017.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 02/07/2023]
Abstract
AIMS The inhibition of mast cells' degranulation may be an approach to prevent the formation of new vessels during the mammary carcinogenesis. MATERIALS AND METHODS Female Sprague-Dawley rats were randomly divided into five experimental groups. Mammary tumors were induced by intraperitoneal injection of N-methyl-N-nitrosourea (MNU). Animals from group II were treated with ketotifen for 18weeks immediately after the MNU administration, while animals from group III only received the ketotifen after the development of the first mammary tumor. Mammary tumors vascularization was assessed by ultrasonography (Doppler, B Flow and contrast-enhanced ultrasound) and immunohistochemistry (vascular endothelial growth factor-A). KEY FINDINGS AND SIGNIFICANCE Similar to what occurs in women with breast cancer, the majority of MNU-induced mammary tumors exhibited a centripetal enhancement order of the contrast agent, clear margin and heterogeneous enhancement. Ultrasonographic and immunohistochemical data suggest that the inhibition of mast cells' degranulation did not change the mammary tumors vascularization.
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Affiliation(s)
- Ana I Faustino-Rocha
- Faculty of Veterinary Medicine, Lusophone University of Humanities and Technologies, Lisbon, Portugal; Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal.
| | - Adelina Gama
- Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences, UTAD, 5001-911 Vila Real, Portugal; Animal and Veterinary Research Center (CECAV), School of Agrarian and Veterinary Sciences, UTAD, 5001-911 Vila Real, Portugal
| | - Paula A Oliveira
- Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences, UTAD, 5001-911 Vila Real, Portugal
| | - Katrien Vanderperren
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Jimmy H Saunders
- Department of Veterinary Medical Imaging and Small Animal Orthopedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Maria J Pires
- Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences, UTAD, 5001-911 Vila Real, Portugal
| | - Rita Ferreira
- Organic Chemistry, Natural Products and Foodstuffs (QOPNA), Mass Spectrometry Center, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Mário Ginja
- Center for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences, UTAD, 5001-911 Vila Real, Portugal
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30
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Park AY, Seo BK, Cha SH, Yeom SK, Lee SW, Chung HH. An Innovative Ultrasound Technique for Evaluation of Tumor Vascularity in Breast Cancers: Superb Micro-Vascular Imaging. J Breast Cancer 2016; 19:210-3. [PMID: 27382399 PMCID: PMC4929264 DOI: 10.4048/jbc.2016.19.2.210] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/26/2016] [Indexed: 01/08/2023] Open
Abstract
Tumor vascularity is an important indicator for differential diagnosis, tumor growth, and prognosis. Superb micro-vascular imaging (SMI) is an innovative ultrasound technique for vascular examination that uses a multidimensional filter to eliminate clutter and preserve extremely low-velocity flows. Theoretically, SMI could depict more vessels and more detailed vascular morphology, due to the increased sensitivity of slow blood flow. Here, we report the early experience of using SMI in 21 breast cancer patients. We evaluated tumor vascular features in breast cancer and compared SMI and conventional color or power Doppler imaging. SMI was superior to color or power Doppler imaging in detecting tumor vessels, the details of vessel morphology, and both peripheral and central vascular distribution. In conclusion, SMI is a promising ultrasound technique for evaluating microvascular information of breast cancers.
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Affiliation(s)
- Ah Young Park
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Bo Kyoung Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang Hoon Cha
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Suk Keu Yeom
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Wha Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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31
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Ma Y, Li G, Li J, Ren WD. The Diagnostic Value of Superb Microvascular Imaging (SMI) in Detecting Blood Flow Signals of Breast Lesions: A Preliminary Study Comparing SMI to Color Doppler Flow Imaging. Medicine (Baltimore) 2015; 94:e1502. [PMID: 26356718 PMCID: PMC4616654 DOI: 10.1097/md.0000000000001502] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/23/2015] [Accepted: 08/11/2015] [Indexed: 12/12/2022] Open
Abstract
The correlation between color Doppler flow imaging (CDFI) and Superb Microvascular Imaging (SMI) for detecting blood flow in breast lesions was investigated, as was the diagnostic value of SMI in differentiating benign from malignant breast lesions.These lesions were evaluated using both CDFI and SMI according to Adler's method. Pathologic examination showed 57 malignant lesions and 66 benign lesions. The number of blood vessels in a single mass was detected by 2 techniques (SMI and CDFI), and the difference between the 2 values (SMI-CDFI) was calculated. The optimal threshold for the diagnosis of malignant neoplasms and the diagnostic performances of SMI, CDFI, and SMI-CDFI were calculated.For the total lesions and malignant lesions alone, the difference between SMI and CDFI for detecting blood flow was significant (P < 0.01), but the difference was not significant for benign lesions (P = 0.15). The area under the receiver operating characteristic curve was 0.73 (95% confidence interval [CI]: 0.64-0.82) for CDFI; 0.81 (95% CI: 0.74-0.89) for SMI; and 0.89 (95% CI: 0.82-0.95) for SMI-CDFI. Furthermore, the modality of "SMI-CDFI" showed the best diagnostic performance.SMI provides further microvessel information in breast lesions. The diagnostic modality of "SMI-CDFI" can improve the diagnostic performance of ultrasound in the differentiation between benign and malignant masses.
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Affiliation(s)
- Yan Ma
- From the Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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32
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Quantitative diagnosis of salivary gland tumors with contrast-enhanced ultrasound--a preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:784-90. [PMID: 24209995 DOI: 10.1016/j.oooo.2013.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 09/05/2013] [Accepted: 09/17/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To quantitatively analyze the value of qualitative diagnosis of salivary gland masses with contrast-enhanced ultrasound (CEUS). STUDY DESIGN The enhanced sonographic features of 68 salivary gland masses were analyzed to differentiate them. The final diagnoses were confirmed by biopsy pathology. RESULTS We observed from the perfusion kinetics of CEUS that most pleomorphic adenomas manifested lower enhancement and well-defined margins; most Warthin tumors presented with higher enhancement and well-defined margins; and most malignant tumors had higher enhancement and poorly defined margins. Their time-intensity curves showed pleomorphic adenomas were hypovascularized with a poor perfusion, whereas Warthin tumors and malignant tumors were hypervascularized with a rich perfusion. Additionally, malignant tumors showed significantly shortened time to peak and richer maximum signal intensity compared with Warthin tumors. CONCLUSIONS The features of salivary gland masses identified with CEUS were helpful in the differential diagnosis of salivary gland masses.
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