Value of Contrast-Enhanced Microflow Imaging in Diagnosis of Breast Masses in Comparison with Contrast-Enhanced Ultrasound

Runlan Luo; Qingyao Wang; Yan Zhang; Wenli Jiang; Yiru Wang; Yukun Luo

doi:10.1016/j.acra.2023.11.021

Value of Contrast-Enhanced Microflow Imaging in Diagnosis of Breast Masses in Comparison with Contrast-Enhanced Ultrasound

Acad Radiol. 2023 Dec 7:S1076-6332(23)00657-8. doi: 10.1016/j.acra.2023.11.021. Online ahead of print.

Authors

Runlan Luo¹, Qingyao Wang², Yan Zhang², Wenli Jiang², Yiru Wang², Yukun Luo³

Affiliations

¹ Medical College, Yangzhou University, No. 136 Jiangyang Middle Rd, Hanjiang District, Yangzhou, Jiangsu, China (R.L.); Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.).
² Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.).
³ Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, No. 28 Fuxing Rd, Haidian District, Beijing, China (R.L., Q.W., Y.Z., W.J., Y.W., Y.L.). Electronic address: luoyukun@301hospital.com.

PMID: 38065749
DOI: 10.1016/j.acra.2023.11.021

Abstract

Rationale and objectives: To investigate the value of contrast-enhanced microflow imaging (CEUS-MFI) in distinguishing benign and malignant breast masses.

Methods: A total of 116 breast masses classified as Breast Imaging Reporting and Data System (BI-RADS) category 3-5 by ultrasound (US) were included. Both contrast-enhanced ultrasound (CEUS) and CEUS-MFI were performed before excision or biopsy, with features and diagnostic efficiency analyzed. The US and CEUS BI-RADS 4A masses were also re-assessed by CEUS-MFI.

Results: The features of CEUS-MFI including both interior and peripheral enlarged, twisted vessels (both P < 0.05), penetrating vessels (P = 0.007), and radial/spiculated vessels (P < 0.001) were more frequently detected in malignant masses, while peripheral annular vessels were mostly observed in benign masses (P < 0.001). Interestingly, a significant difference in the orientation of penetrating vessels between benign and malignant masses was found (P < 0.001), with parallel orientation mostly displayed in benign masses, while vertical or multiple-direction orientation mostly displayed in malignant masses. The microvascular architecture of breast masses was categorized into five patterns: avascular, line-like, tree-like, root hair-like, and crab claw-like pattern. Benign masses mainly displayed tree-like pattern (77.1% vs 10.9%, P < 0.05); malignant masses mainly displayed root hair-like (34.8% vs 5.7%, P < 0.05) and crab claw-like patterns (50.0% vs 1.4%, P < 0.05). The diagnostic efficiency of CEUS-MFI was higher relative to CEUS and US. In addition, CEUS-MFI decreased the biopsy rates of US and CEUS BI-RADS 4A masses without missing malignancies.

Conclusion: CEUS-MFI could be a valuable and promising technique in diagnosis of breast masses, and could provide more diagnostic information for radiologists.

Keywords: Breast neoplasms; Contrast media; Diagnostic imaging; Mammary ultrasonography; Microvessels.