Benefits of Superb Microvascular Imaging in Vascularity Evaluation of Breast Masses: Diagnostic Performance Comparision with Color and Power Doppler Imaging

Öz

Objective: This study aims to compare findings of Color Doppler Imaging (CDI), Power Doppler Imaging (PDI) and Superb Microvascular Imaging (SMI) with histopathological results to evaluate their diagnostic efficacy for evaluating the vascularity in breast masses. Methods: Gray-scale US, CDI, PDI, and SMI were performed on 46 patients who met the inclusion criteria during the specified date range. The vascularity characteristics of each mass were recorded and compared. Results: Of the 46 breast lesions, 26 were benign and 20 were malignant. While all 20 malignant lesions were invasive ductal carcinoma, benign lesions included 19 fibroadenomas, 5 granulomatous mastitis and 2 sclerosing adenosis. Mean size was 21.5± 9.6mm in benign lesions and 12.4± 5.8mm in malignant lesions. Color SMI (cSMI) detected more penetrating vessels (PV) in malignant lesions than benign lesions, and the number of PV detected by cSMI for malignant lesions was higher than those detected by CDI and PDI. In benign lesions, less PV was detected with cSMI and CDI than PDI. When the presence of PV was used as a criterion for the diagnosis of malignancy, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of cSMI were higher than CDI and PDI. In distinguishing vascular patterns in breast lesions, the sensitivity, PPV, NPV, and diagnostic accuracy of cSMI were higher, while the specificity was lower than those of CDI and PDI. Conclusion: cSMI shows more vascular branching details than CDI and PDI and is a viable method in differentiating benign-malignant breast lesion.

Anahtar Kelimeler

• Breast mass
• CDI
• PDI
• SMI
• benign
• malignant

Meme Kitlelerinin Vaskülaritesini Değerlendirmede Süperb Mikrovasküler Görüntülemenin Faydaları: Renkli ve Power Doppler Görüntüleme ile Tanısal Performans Karşılaştırması

Öz

Amaç: Bu çalışmanın amacı meme kitlelerindeki vaskülariteyi değerlendirmek için, Renkli Doppler Görüntüleme (RDG), Power Doppler Görüntüleme (PDG) ve Süperb Mikrovasküler Görüntüleme (SMG) yaparak elde ettiğimiz bulguları, histopatolojik sonuçlar ile karşılaştırıp tanısal etkinliklerini değerlendirmektir. Yöntem: Belirtilen tarih aralığında, dahil etme kriterlerine uygun 46 hastaya gri skala USG, RDG, PDG ve SMG yapıldı. Her bir kitlenin vaskülarite özellikleri kaydedildi ve karşılaştırıldı. Bulgular: Kırk altı meme lezyonundan 26’sı benign ve 20’si maligndi. 26 benign lezyondan 19 tanesi fibroadenom, 5 tanesi granülomatöz mastit ve 2 tanesi sklerozan adenozis iken 20 malign lezyonun tamamı invaziv duktal karsinomdu. Benign lezyonlarda ortalama boyut 21,5± 9,6mm, malign lezyonlarda 12,4± 5,8mm idi. Renkli SMG (rSMG) ile malign lezyonlarda benign lezyonlardan daha fazla penetran damar (PV) tespit edilmiş olup malign lezyonlar için rSMG tarafınca tespit edilen PV sayısı, RDG ve PDG tarafınca tespit edilenden daha fazladır. Benign lezyonlarda rSMG ve RDG ile, PDG’ye kıyasla daha az PV tespit edildi. PV varlığı malignite tanısı için bir kriter olarak kullanıldığında, rSMG’nin duyarlılık, özgüllük, pozitif prediktif değer (PPD), negatif prediktif değer (NPD) ve tanısal doğruluğu, RDG ve PDG'ninkinden daha yüksekti. RDG ve PDG ile karşılaştırıldığında, rSMG ile daha fazla akım sinyali ve damar morfolojisi tespit edildi. Meme lezyonlarındaki vasküler paternlere göre farklı görüntüleme modalitelerinin tanısal etkinliğinde rSMG’nin duyarlılık, PPD, NPD ve tanısal doğruluğu, RDG ve PDG’ninkinden daha yüksekken, özgüllüğü daha düşüktü. Sonuç: rSMG, RDG ve PDG’den daha fazla vasküler dallanma detayı göstermekte olup benign-malign meme lezyonunun ayırt edilmesinde uygulanabilir bir yöntemdir.

Anahtar Kelimeler

• Meme kitlesi
• RDG
• PDG
• SMG
• Benign
• Malign

Kaynakça

1. Hendrick RE, Smith RA, Rutledge JH 3rd, Smart CR. Benefit of screening mammography in women aged 40–49: a new meta-analysis of randomized controlled trials. J Natl Cancer Inst Monogr. 1997;22:87-92.
2. Martin FT, O’Fearraigh C, Hanley C, Curran C, Sweeney KJ, Kerin MJ. The prognostic significance of nodal ratio on breast cancer recurrence and its potential for incorporation in a new prognostic index. Breast J. 2013;19(4):388-393
3. Kono T, Kazutoshi F, Gen N. Superb Micro-Vascular Imaging (SMI): Clinical advantages of a novel US flow technique in pediatric diagnostic imaging. Asian and Oceanic Forum for Pediatric Radiology. 2017;4:18-23.
4. Karahan AY, Serdar A, Banu O, Bakdik S, Ekiz T. Superb microvascular imaging of the median nerve in Carpal Tunnel Syndrome: An electrodiagnostic and Ultrasonographic study. J. Med. Ultrasound. 2018;37(12):2855-2861.
5. Machado P, Segal S, Lyshchik A, Forsberg F. A novel microvascular flowtechnique: initial results in thyroids. Ultrasound Q. 2016; 32(1):67-74.
6. Durmaz MS, Akyürek N, Kara T, Ateş F, Özbakir B, Durmaz F, Karaağaç S. Quantitative assessment of thyroid gland vascularization with vascularization index using color superb microvascular imaging in pediatric patients with Hashimoto thyroiditis. Ultrasound Q. 2019; 35(3):281-289.
7. Kong J, Li JC, Wang HY, Wang YH, Zhao RN, Zhang Y, Jin J. Role of superb micro-vascular imaging in the preoperative evaluation of thyroid nodules: Comparison with power Doppler low imaging. J Ultrasound Med. 2017; 36:1329–1337.
8. Fox SB, Generali DG, Harris AL. Breast tumour angiogenesis. Breast Cancer Res. 2007; 9:216.

9. Stanzani D, Chala LF, Barros Nd, Cerri GG, Chammas MC. Can Doppler or contrast-enhanced ultrasound analysis add diagnostically important information about the nature of breast lesions? Clinics (Sao Paulo). 2014; 69:87-92.
10. Bakdik S, Arslan S, Oncu F, Durmaz MS, Altunkeser A, Eryilmaz MA, Unlu Y. Effectiveness of superb microvascular imaging for the differentiation of intraductal breast lesions. Med Ultrason. 2018; 20(3): 306-312.
11. Rouzier R, Perou CM, Symmans WF, et al. Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res. 2005; 11:5678-5685.
12. Ma Y, Li G, Li J, Ren WD. The diagnostic value of superb microvascularimaging (SMI) in detecting blood flow signals of breast lesions: a preliminarystudy comparing SMI to color Doppler flow imaging. Medicine (Baltimore). 2015; 94:e1502.
13. Park AY, Kwon M, Woo OH, et al. 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. 2019; 20:759-772.
14. Cai SM, Wang HW, Zhang XY, et al. The vascular index of superb microvascular imaging can improve the diagnostic accuracy for breast imaging reporting and data system category 4 breast lesions. Cancer Manag Res. 2020; 12:1819-1826.
15. Zhu YC, Zu DM, Zhang Y, et al. A comparative study on superb microvascular imaging and conventional ultrasonography in differentiating BI-RADS 4 breast lesions. Oncol Lett. 2019; 18:3202-3210.
16. Diao, Xuehong, et al. Role of superb microvascular imaging in differentiating between malignant and benign solid breast masses. Clin. Breast Cancer. 2020; 20(6): e786-e793.
17. Stuhrmann M, Aronius R, Schietzel M. Tumor vascularity of breast lesions: potentials and limits of contrast-enhanced Doppler sonography. AJR Am J Roentgenol. 2000; 175:1585-1589.
18. Sirous M, Sirous R, Nejad FK, Rabeie E, Mansouri M. Evaluation of different aspects of power Doppler sonography in differentiating and prognostication of breast masses. J Res Med Sci. 2015; 20:133-139.
19. Cho N, Jang M, Lyou CY, Park JS, Choi HY, Moon WK. Distinguishing benign from malignant masses at breast US: combined US elastography and color Doppler US-influence on radiologist accuracy. Radiology. 2012; 262:80-90.
20. Xiao XY, Chen X, Guan XF, Wu H, Qin W, Luo BM. Superb microvascular imaging in diagnosis of breast lesions: a comparative study with contrast enhanced ultrasonographic microvascular imaging. Br J Radiol. 2016; 89:20160546.
21. Zhu YC, Zu DM, Zhang Y, et al. A comparative study on superb microvascular imaging and conventional ultrasonography in differentiating BI-RADS 4 breast lesions. Oncol Lett. 2019; 18:3202-3210.
22. Park, AY, Seo, BK, Woo, OH, et al. 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(3): 304-311.
23. Yongfeng, Z, Ping, Z, Wengang, L, Yang, S, Shuanming, T. Application of a novel microvascular imaging technique in breast lesion evaluation. Ultrasound Med Biol. 2016; 42(9): 2097-2105.
24. Schroeder RJ, Bostanjoglo M, Rademaker J, Maeurer J, Felix R. Role of power Doppler techniques and ultrasound contrast enhancement in the differential diagnosis of focal breast lesions. Eur Radiol. 2003; 13:68-79.
25. Sencha AN, Evseeva EV, Mogutov MS, Patrunov YN. Ultrasound diagnosis of breast cancer. Berlin/Heidelberg: Springer; 2013:49-122.