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Juvenile fibroadenoma in the left breast of an 18-year-old woman. A) A gray-scale image showing an oval, circumscribed mass (BI-RADS 3). B) A color Doppler image showing a hypervascular lesion with central and regular arteries. C) An enhanced color Doppler image showed the same pattern as the unenhanced CDUS. Power Doppler imaging was used only to produce clearer images for illustration purposes. D) After contrast injection, there was intense enhancement.
Source publication
Despite evidence suggesting that Doppler ultrasonography can help to differentiate between benign and malignant breast lesions, it is rarely applied in clinical practice. The aim of this study was to determine whether certain vascular features of breast masses observed by duplex Doppler and color Doppler ultrasonography (before and/or after microbu...
Citations
... (2,5,6) The most common radiographic modalities of choice for the screening and diagnosis of breast pathologies are 23.00 (14.00-37.00) 16.00 (16.00-32.00) Description: For numeric data the P value is tested with an unpaired T test because the data is normally distributed. ...
... CDFI cannot display microvessels with a low flow rate. PDI is susceptible to interfere with non-blood flow information, and contrast agents used by CEUS require administration into the patient and involve additional costs (7,8). Compared with those techniques, SMI without the use of contrast agents is a novel imaging technique for better displaying microvessels where the blood flow is at low speed (9). ...
Background
Neovascularity visualization in breast nodules is challenging due to the limitations of conventional Doppler imaging methods. This study aims to assess the performance of superb microvascular imaging (SMI) in evaluating the microvascularity of breast nodules (diameter ≤2 cm). The comparison of performances of SMI with color Doppler flow imaging (CDFI) and power Doppler imaging (PDI) was made by using a three-factor scoring system of vascularity. This study also investigated the common features of microvascularity in small malignant nodules on SMI for early differentiating from benign nodules.
Methods
Ninety-one female patients (with 125 breast nodules) were enrolled in this retrospective study. All the breast nodules were examined by grayscale ultrasonography (US), CDFI, PDI, and SMI. The number, morphologic features, and distribution of blood vessels were scored to evaluate the nodular vascularity in light of the three-factor scoring system. The diagnostic value of SMI for microvascularity in breast nodules was analyzed and compared with CDFI and PDI.
Results
Histological analysis showed 53 malignant and 72 benign nodules. The vascularity grades detected by SMI were significantly different from those of CDFI and PDI (P<0.05). SMI detected 47 grade-IV nodules of the total 125 nodules (37.6%), which was more than those detected by CDFI (10.4%, 13/125) and PDI (12.8%, 16/125), while more grade-I nodules were detected by CDFI (42.4%, 53/125) and PDI (36.8%, 46/125) compared with SMI (21.6%, 27/125). Differences in the vessel number, morphologic features, and distribution between benign and malignant breast nodules were significant on SMI (P<0.05). The vessel number ≥6, penetrating vessels, and a mixed distribution of vessels in peripheral and central nodular tissues were the common features of microvascularity in the grade-IV malignant nodules on SMI, whereas the blood vessels in the benign nodules were straight and branching and peripherally distributed.
Conclusions
In comparison with CDFI and PDI, SMI enhances microvascularity detection, depicts the microvascular architecture in breast nodules and has potential in the differential diagnosis of malignant nodules from benign nodules.
... Se cree que la neoangiogénesis es causada por la proteína angiogénica que genera una red vascular local altamente densa en capilares, loops y shunts arterio-venosos, por lo cual los neovasos tienen una apariencia tortuosa, son de calibre irregular y de paredes finas, sin presencia de músculo liso en su pared, con una ramificación aleatoria o "caótica" y se presenta generalmente hacia la periferia de la lesión, lo que permite que la célula maligna crezca más allá de un punto en particular (el tumor no puede crecer más de 1 a 2 mm sin reclutar nuevos capilares sanguíneos).[17][18][19][20][21][22][23][24][25][26] El fundamento de la imagen de Doppler en el cáncer de mama se basa en la angiogénesis del tumor y el gradiente de vascularidad de la masa.22 ...
... Se cree que la neoangiogénesis es causada por la proteína angiogénica que genera una red vascular local altamente densa en capilares, loops y shunts arterio-venosos, por lo cual los neovasos tienen una apariencia tortuosa, son de calibre irregular y de paredes finas, sin presencia de músculo liso en su pared, con una ramificación aleatoria o "caótica" y se presenta generalmente hacia la periferia de la lesión, lo que permite que la célula maligna crezca más allá de un punto en particular (el tumor no puede crecer más de 1 a 2 mm sin reclutar nuevos capilares sanguíneos).[17][18][19][20][21][22][23][24][25][26] El fundamento de la imagen de Doppler en el cáncer de mama se basa en la angiogénesis del tumor y el gradiente de vascularidad de la masa.22 Se ha demostrado que el flujo en la enfermedad benigna es subjetivamente menor que en lesiones malignas, mientras que una alta señal Doppler del flujo sanguíneo tumoral se asoció con mayor extensión de la enfermedad Por lo anterior, se podría pensar que una vascularización aumentada en Doppler color (DC) incrementa la posibilidad de malignidad de un nódulo. ...
El cáncer de mama es una enfermedad de evolución natural compleja que sigue siendo un gran problema de salud pública a nivel mundial. La mastografía es el método de tamizaje para la detección precoz del cáncer de mama que ha demostrado mayor utilidad y que ayuda a disminuir la mortalidad, sin embargo, el ultrasonido mamario es una valiosa herramienta diagnóstica complementaria, que ayuda a realizar un mejor análisis de las lesiones y que incorpora herramientas como el Doppler o la elastografía. Por medio del Doppler se puede valorar el grado de vascularidad de la lesión, así como los distintos comportamientos de los vasos, lo que ayuda a hacer una aproximación mayor para determinar si una lesión cumple con características benignas o malignas. El índice de Resistencia es un parámetro del Doppler espectral que ha demostrado un incremento en lesiones malignas. Palabras Clave: Cáncer de mama, Ultrasonido Doppler, Doppler espectral, Índice de resistencia.
... 8 Malign meme lezyonları genellikle hızlı büyüdükleri için yüksek metabolik faaliyet gösterip yeni gelişen mikrovasküler yapılara ihtiyaç duyarlar. 9 Malign meme lezyonları benign lezyonlara kıyasla daha çok vaskülarite göstermekte ve neovaskülarizasyon ile düzensiz vasküler yapılar oluşturmaktadırlar. 10 ...
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.
... Our study proved that malignant lesions have more vascularity as compared to benign ones which were in line with the study done by Davoudi et al. [5] Similar findings were also found in a recent study done by Al Hialy et al., [20] Stanzani et al., [21] and Waqar, et al [ Table 7]. [22] Seventy-six lesions were found to have hypervascularity on Doppler, out of which 62 (81.6%) were malignant whereas 14 (18.4%) ...
... It was concluded that 89% (65 out of 73) malignant lesions had vascularity; out of which 85% (62) were hypervascular suggesting hypervascularity is an important predictor of malignancy. Similar findings were seen in a study done by Stanzani et al. [21] Most of the benign lesions 63.4% (106 out of 167) were avascular, 28% (47) had hypovascularity whereas only 8% were hypervascular benign lesions. Similar findings were found in a study done by Gupta et al., [19] Davoudi et al., [5] and Al Hialy et al. [20] The positive and NPVs of Blood flow is increased in tumors, which increases velocity and lowers resistance from normal tissue. ...
... Malignant tumors secrete Proangiogenic factors, which accelerates vascularization leading to formation of new blood vessels. Neo angiogenetic vessels are irregular and tortuous in course having variable caliber, and they create reticular networks leading to formation of arteriovenous shunts and dichotomous branching, which distinguishes them from native vessels [12]. ...
... Stanzani, Daniela, et al. [12] conducted another investigation in 2014 to see if specific features of vascularity of breast masses using color and duplex Doppler will add to the analysis done by gray-scale sonography and support the Ultrasound lexicon of BIRADS categorization. They studied 70 solid lesions and found a link between vascularity and spectral index and histology. ...
The incidence of breast malignancy has displayed a rapid rise in recent times. It is one of the most common malignancies found in women. Women should be educated and made aware about self breast examination in order to detect malignancies at an early stage so that the prognosis can be improved. Breast pathologies can be classified into malignant and benign ones on the basis of signs and symptoms and by ultrasonography but can be confirmed on histopathology which remains the gold standard. Breast ultrasonography is the most common non ionizing radiological investigation used to assess breast lesions especially in women with dense or painful breasts. Breast carcinomas appear irregularly shaped hypoechoic lesions with non-circumscribed margins, but these features can rarely be manifested by benign lesions as well. Recent introduction of doppler ultrasound has led to an increase in the sensitivity of detecting breast carcinoma since most of the breast malignancies are hyper vascular and they show high resistivity index on spectral analysis. Angiogenesis in malignant lesions lead to formation of structurally abnormal and tortuous vessels with increased resistive index. Several studies on doppler analysis of breast malignancies have shown Doppler ultrasound to be a safe and effective modality showing acceptable diagnostic accuracy for non-invasive characterization of malignant breast lesions. Therefore, it can be employed as an alternative to histopathology in patients who present with breast lesions.
... The angiogenesis of breast cancer is heterogeneous and highly distorted. The rapid growth of the tumor leads to necrosis, degeneration and calcification in the central area of the tumor, which makes it full of connective tissue and fibrous tissue and hard in texture, which is not conducive to angiogenesis (29)(30)(31). At the same time, some special pathological types of breast cancers are deficient in blood supply, such as mucinous carcinoma, which is rich in a large amount of mucin, with few stromal components and little angiogenesis (32). ...
Background
To explore whether superb microvascular imaging (SMI)SMI can improve the diagnostic efficiency by evaluating the vascular index (VI) and vascular architecture (VA) in breast lesions.
Methods
This is a retrospective study of data collected prospectively for research use. Taking 225 consecutive cases of breast lesions from November 2016 to December 2017 as a training set, the VI values and VA types of benign and malignant lesions were calculated based on the pathological results. Taking 238 consecutive cases of breast lesions from January 2018 to October 2018 as the verification set, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated to compare the diagnostic efficacy.
Results
The training set included 225 breast lesions and the validation set 238 breast lesions. The VI value in the malignant group (10.3 ± 8.0) was significantly higher than that in the benign group (4.3 ± 5.0)(P<0.001). A VI value of 4.05 was used as the diagnostic threshold for differentiating benign from malignant lesions, with a sensitivity of 80.5%, a specificity of 61.9%, an accuracy of 71.1%, a PPV of 62.9%, a NPV of 76.9%, and an area under the curve of 0.758 (0.696-0.819). There was a significant difference in the types of benign and malignant VA (P < 0.001), and the PPV of the root hair-like and crab claw-like VAs were 93.9% and 100.0%, respectively. The diagnostic sensitivity, specificity, accuracy, PPV, NPV and area under the AUC curve were 58.0%, 98.2%, 97.0%, 70.3% and 0.781, respectively (95%CI: 0.719-0.844). SMI combined with conventional ultrasound improved the diagnostic specificity (70.0% vs. 90.0%), accuracy (87.4% vs. 96.6%), and PPV (82.5% vs. 93.2%) without decreasing the diagnostic sensitivity (99.3%), yielded higher diagnostic performance with the area under the ROC curve was 0.941 (95%CI: 0904-0.979) compared with conventional US alone (P < 0.001).
Conclusion
A VI value 4.05 is a cut-off value with good diagnostic efficacy. The residual root-like and crab claw-like VAs are the characteristic VAs of malignant lesions. Conventional ultrasound combined with the VI and VA can improve the diagnostic specificity, accuracy and PPV without reducing the diagnostic sensitivity.
... Cancerous growths release vascular growth factors, which promote development of newer vessels. 11 However these vessels are tortuous with an abnormal structure, resulting in increased resistance to blood. Thus, doppler ultrasound of malignant masses reveals a higher Resistance Index (RI) as compared to benign growths or normal tissue. ...
... Malignant lesions also have features such as central vascularity, hypervascularity or tortuous vessels while benign lesions are predominantly usually have normal or reduced number of vessels. 11 Histopathology is contemplated as investigation of choice to ascertain the nature of pathology, differentiation of benign from malignant tumors and determination of tumor grade. 12 However, apart from being invasive, it may result in an array of potential unpleasant side effects like bleeding, infection or damage to adjacent nerves, vessels and viscera. ...
Objectives: To evaluate breast lesions with doppler ultrasound and calculated the diagnostic accuracy of resistive index as a predictor of malignancy, taking histopathology as gold standard. Study Design: Cross-sectional study. Setting: Radiology Department, CMH Multan. Period: December 2015 to May 2016. Material & Methods: 150 female patients, having age between 20 – 60 years, with palpable breast lumps were admitted in the study. Doppler ultrasound of the lesion was performed with emphasis on the vascularity and resistive index was formulated. Categorization as malignant or otherwise was declared as established by doppler ultrasound. Patients then underwent biopsy followed by histopathology. Correlation of doppler ultrasound and histopathological findings was done with calculation of diagnostic accuracy of doppler ultrasound, keeping histopathology as gold standard. Results: The mean of age was 40.23 ± 5.75 years. In 81 breast doppler ultrasound positive patients, 73 (True Positive) showed malignant lesions in breast while 08 (False Positive) did not have malignancy on biopsy. Among 69 Breast Doppler Ultrasound negative patients, 06 (False Negative) demonstrated malignancy on biopsy whereas 63 (True Negative) did not have any malignant lesion. Overall specificity was 88.77%, sensitivity 92.40%, negative predictive value 91.30%, positive predictive value 90.12% and diagnostic accuracy of Doppler Ultrasound came out 90.67%. Conclusion: Angiogenesis in malignant lesions lead to formation of structurally abnormal and tortuous vessels with increased resistive index. Doppler ultrasound is a safe and effective modality which shows acceptable diagnostic accuracy for noninvasive characterization of malignant breast lesions. Therefore, it can be employed as an alternative to histopathology in patients who present with breast lesions.
... Other ultrasound imaging approaches have been used for visualizing tumor vasculature in clinical applications. Previous studies with Doppler and contrast-Doppler images of breast lesions have found that the detection of penetrating vessels is highly suggestive of malignancy [23][24][25]. Other features visible in Doppler imaging that suggested malignancy were hypervascularity and tortuosity. ...
The purpose of this study is to determine if microvascular tortuosity can be used as an imaging biomarker for the presence of tumor-associated angiogenesis and if imaging this biomarker can be used as a specific and sensitive method of locating solid tumors. Acoustic angiography, an ultrasound-based microvascular imaging technology, was used to visualize angiogenesis development of a spontaneous mouse model of breast cancer (n=48). A reader study was used to assess visual discrimination between image types, and quantitative methods utilized metrics of tortuosity and spatial clustering for tumor detection. The reader study resulted in an area under the curve of 0.8, while the clustering approach resulted in the best classification with an area under the curve of 0.95. Both the qualitative and quantitative methods produced a correlation between sensitivity and tumor diameter. Imaging of vascular geometry with acoustic angiography provides a robust method for discriminating between tumor and healthy tissue in a mouse model of breast cancer. Multiple methods of analysis have been presented for a wide range of tumor sizes. Application of these techniques to clinical imaging could improve breast cancer diagnosis, as well as improve specificity in assessing cancer in other tissues. The clustering approach may be beneficial for other types of morphological analysis beyond vascular ultrasound images.
... Stanzani et al, demonstrated that RI ≥0.73 is significantly predictive of malignancy. 16 Turbulent flow with high velocity and significant broadening of Doppler spectrum was also found in some of the cases due to presence of stenotic vessels. ...
Background: Breast cancer is the most common malignancy in female worldwide. Ultrasound (US) is a safe and easily available modality for evaluation of breasts in females of all age groups. It can detect characteristic features of breast malignancy with high degree of accuracy. This study was undertaken with the aims to evaluate the ultrasonographic features of malignant breast mass, to identify the most commonly encountered gray scale ultrasound findings and to study the role of Doppler ultrasound in those cases.Methods: The study was conducted in Dr B. Borooah Cancer Institute, Guwahati from January 2018 to January 2019. Gray scale ultrasound including Doppler study was done in all the female patients coming with palpable breast lump or with nipple discharge and images were archived. The archived images of a total number of 108 patients with biopsy report positive for malignancy were retrospectively studied and the ultrasound findings were evaluated.Results: Most common gray scale ultrasound features for malignant breast masses were hypoechoic mass, taller than wide, irregular shape, having spiculated margins, neither posterior acoustic enhancement nor shadowing, presence of intralesional microcalcifications and surrounding echogenic halo. Hypervascularity, noticeable difference in waveform pattern between central and peripheral vessels, high resistance flow pattern with absent or reversal of diastolic flow were the common Doppler findings.Conclusions: Combination of Doppler with gray scale ultrasound has emerged as a very important technique in diagnosing malignant breast mass with high accuracy.
