A comparative study on superb microvascular imaging and conventional ultrasonography in differentiating BI‑RADS 4 breast lesions

Zhu,Yi‑Cheng; Zu,Dao‑Ming; Zhang,Yuan; Shan,Jun; Shi,Xiu‑Rong; Deng,Shu‑Hao; Jiang,Quan

doi:10.3892/ol.2019.10603

A comparative study on superb microvascular imaging and conventional ultrasonography in differentiating BI‑RADS 4 breast lesions

Authors:
- Yi‑Cheng Zhu
- Dao‑Ming Zu
- Yuan Zhang
- Jun Shan
- Xiu‑Rong Shi
- Shu‑Hao Deng
- Quan Jiang
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Affiliations: Department of Ultrasound, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201299, P.R. China, Department of Minor Surgery, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 201299, P.R. China
Published online on: July 11, 2019 https://doi.org/10.3892/ol.2019.10603
Pages: 3202-3210
Copyright: © Zhu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

This prospective study aimed to explore the diagnostic value of superb microvascular imaging (SMI) in differentiating Breast Imaging Reporting and Data System (BI‑RADS) 4 breast lesions compared with conventional ultrasonography (US). A total of 111 patients with 116 breast lesions underwent grayscale ultrasound (US), colour Doppler flow imaging (CDFI) and SMI breast imaging between February 2016 and May 2018. CDFI and SMI were performed to evaluate vascular quantity, morphology, and distribution characteristics. The detection of malignancy was compared between grayscale US alone, US + CDFI and US + SMI in terms of the BI‑RADS stratification system. SMI was observed to be significantly more accurate in distinguishing malignant breast lesions (86.67%) compared with CDFI (80.00%) (P<0.001). Among malignant lesions, SMI detected 80.00% of those that contained ≥4 vessels, while CDFI only detected 56.67%. Penetrating and branching vessels were identified by SMI in 53.33% of malignant breast lesions and by CDFI in 10.00%. There was no significant difference in vascular distribution by SMI (P=0.094) and by CDFI (P=0.087). US + SMI was associated with higher sensitivity, specificity, and accuracy rates (86.67, 83.72 and 84.48%, respectively) compared with US + CDFI (80.00, 72.09 and 74.14%, respectively). The area under the curve values from receiver operating characteristic analysis of US + SMI, US + CDFI and US alone were 0.852 [95% confidence interval (CI): 0.768‑0.936)] 0.760 (95% CI: 0.660‑0.860), 0.698 (95% CI: 0.589‑0.807), respectively (P<0.001). SMI yielded more detailed vascular information associated with malignant breast masses when compared with conventional US. Therefore, as an adjunct to grayscale, SMI exhibited a markedly improved diagnostic capability in distinguishing malignant and benign breast lesions, particularly those of BI‑RADS category 4.

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1	Li T, Mello-Thoms C and Brennan PC: Descriptive epidemiology of breast cancer in China: Incidence, mortality, survival and prevalence. Breast Cancer Res Treat. 159:395–406. 2016. View Article : Google Scholar : PubMed/NCBI
2	Rezaee A, Buck A, Raderer M, Langsteger W and Beheshti M: Chapter 3-breast cancer BT-PET/CT in cancer: An interdisciplinary approach to individualized imaging. Elsevier. 43–63. 2018.
3	Folkman J: Angiogenesis in cancer, vascular, rheumatoid and other disease. Nat Med. 1:27–31. 1995. View Article : Google Scholar : PubMed/NCBI
4	Stratman AN, Yu JA, Mulligan TS, Butler MG, Sause ET and Weinstein BM: Chapter 24-blood vessel formation, editor(s): Sally a. Moody, Principels of developmental genetics (Second edition). Academic Press; pp. 421–449. 2015
5	Lee SH, Chung J, Choi HY, Choi SH, Ryu EB, Ko KH, Koo HR, Park JS, Yi A, Youk JH, et al: Evaluation of screening US-detected breast masses by combined use of elastography and color doppler US with B-mode US in women with dense breasts: A multicenter prospective study. Radiology. 285:660–669. 2017. View Article : Google Scholar : PubMed/NCBI
6	Kook SH, Park HW, Lee YR, Lee YU, Pae WK and Park YL: Evaluation of solid breast lesions with power Doppler sonography. J Clin Ultrasound. 27:231–237. 1999. View Article : Google Scholar : PubMed/NCBI
7	Park AY, Seo BK, Woo OH, Jung KS, Cho KR, Park EK, Cha SH and 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. 73:304–311. 2018. View Article : Google Scholar : PubMed/NCBI
8	Zhu YC, Zhang Y, Deng SH and Jiang Q: A prospective study to compare superb microvascular imaging with grayscale ultrasound and color doppler flow imaging of vascular distribution and morphology in Thyroid nodules. Med Sci Monit. 24:9223–9231. 2018. View Article : Google Scholar : PubMed/NCBI
9	Dubinsky TJ, Revels J, Wang S, Toia G, Sonneborn R, Hippe DS and Erpelding T: Comparison of Superb Microvascular Imaging with color flow and power doppler imaging of small hepatocellular carcinomas. J Ultrasound Med. 37:2915–2924. 2018. View Article : Google Scholar : PubMed/NCBI
10	He MN, Lv K, Jiang YX and Jiang TA: Application of superb microvascular imaging in focal liver lesions. World J Gastroenterol. 23:7765–7775. 2017. View Article : Google Scholar : PubMed/NCBI
11	Mercado CL: BI-RADS update. Radiol Clin North Am. 52:481–487. 2014. View Article : Google Scholar : PubMed/NCBI
12	Levy L, Suissa M, Chiche JF, Teman G and Martin B: BIRADS ultrasonography. Eur J Radiol. 61:202–211. 2007. View Article : Google Scholar : PubMed/NCBI
13	Strigel RM, Burnside ES, Elezaby M, Fowler AM, Kelcz F, Salkowski LR and DeMartini WB: Utility of BI-RADS assessment category 4 subdivisions for screening breast MRI. AJR Am J Roentgenol. 208:1392–1399. 2017. View Article : Google Scholar : PubMed/NCBI
14	Raza S, Goldkamp AL, Chikarmane SA and Birdwell RL: US of breast masses categorized as BI-RADS 3, 4, and 5: Pictorial review of factors influencing clinical management. Radiographics. 30:1199–1213. 2010. View Article : Google Scholar : PubMed/NCBI
15	Adler DD, Carson PL, Rubin JM and Quinn-Reid D: Doppler ultrasound color flow imaging in the study of breast cancer: Preliminary findings. Ultrasound Med Biol. 16:553–559. 1990. View Article : Google Scholar : PubMed/NCBI
16	Durand MA and Hooley RJ: Implementation of whole-breast screening ultrasonography. Radiol Clin North Am. 55:527–539. 2017. View Article : Google Scholar : PubMed/NCBI
17	Niell BL, Freer PE, Weinfurtner RJ, Arleo EK and Drukteinis JS: Screening for breast cancer. Radiol Clin North Am. 55:1145–1162. 2017. View Article : Google Scholar : PubMed/NCBI
18	Thomas L and Szabo: Chapter 11-Doppler modes in diagnostic ultrasound imaging: Inside out (Second edition). Academic Press; pp. 431–500. 2014
19	Lu R, Meng Y, Zhang Y, Zhao W, Wang X, Jin M and Guo R: Superb microvascular imaging (SMI) compared with conventional ultrasound for evaluating thyroid nodules. BMC Med Imaging. 17:652017. View Article : Google Scholar : PubMed/NCBI
20	Durmaz MS and Sivri M: Comparison of superb micro-vascular imaging (SMI) and conventional Doppler imaging techniques for evaluating testicular blood flow. J Med Ultrason. 45:443–452. 2001. View Article : Google Scholar
21	Lee DH, Lee JY and Han JK: Superb microvascular imaging technology for ultrasound examinations: Initial experiences for hepatic tumors. Eur J Radiol. 85:2090–2095. 2016. View Article : Google Scholar : PubMed/NCBI
22	Ma Y, Li G, Li J and 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). 94:e15022015. View Article : Google Scholar : PubMed/NCBI
23	Zhu YC, Zhang Y, Deng SH and Jiang Q: Diagnostic performance of superb microvascular imaging (SMI) combined with shear-Wave elastography in evaluating breast lesions. Med Sci Monit. 24:5935–5942. 2018. View Article : Google Scholar : PubMed/NCBI
24	Less JR, Skalak TC, Sevick EM and Jain RK: Microvascular architecture in a mammary carcinoma: Branching patterns and vessel dimensions. Cancer Res. 51:265–273. 1991.PubMed/NCBI
25	Williams RG: The vascularity of normal and neoplastic grafts in vivo. Cancer Res. 11:139–144. 1951.PubMed/NCBI
26	Kopeć M and Abramczyk H: Angiogenesis-a crucial step in breast cancer growth, progression and dissemination by Raman imaging. Spectrochim Acta Part A Mol Biomol Spectrosc. 198:338–345. 2018. View Article : Google Scholar
27	Raza S and Baum JK: Solid breast lesions: Evaluation with power Doppler US. Radiology. 203:164–168. 1997. View Article : Google Scholar : PubMed/NCBI
28	Xiao XY, Chen X, Guan XF, Wu H, Qin W and Luo BM: Superb microvascular imaging in diagnosis of breast lesions: A comparative study with contrast-enhanced ultrasonographic microvascular imaging. Br J Radiol. 89:201605452016. View Article : Google Scholar
29	Zhan J, Diao XH, Jin JM, Chen L and Chen Y: Superb microvascular imaging-A new vascular detecting ultrasonographic technique for avascular breast masses: A preliminary study. Eur J Radiol. 85:915–921. 2016. View Article : Google Scholar : PubMed/NCBI
30	Yen PL, Wu HK, Tseng HS, Kuo SJ, Huang YL, Chen HT and Chen DR: Vascular morphologic information of three-dimensional power Doppler ultrasound is valuable in the classification of breast lesions. Clin Imaging. 36:267–271. 2012. View Article : Google Scholar : PubMed/NCBI