Application Value Of Superb Microascular Imaging In BI-RADS-4 Breast Lesions

Objectives: To evaluate the clinical value of superb microvascular imaging techniques for the diagnosis of benign and malignant nature of BI-RADS-4(breast imaging reporting and data system,BI-RADS)type of breast lesions.Methods: Patients who visited our department for breast ultrasound examination from November 2021 to December 2022 were collected,and 100 breast lesions with BI-RADS classification of 4 categories and pathological diagnosis were included in the study.Two-dimensional sonograms,color Doppler flow imaging(CDFI),and superb microvascular imaging(SMI)of the lesions were obtained by ultrasound scanning;the blood supply of the lesions was graded by Adler by CDFI and SMI;three-dimensional superb microvascular imaging(SMI)was performed.Superb microvascular imaging smart three-dimensional(SMI-3D)technology to assess the vascular architecture(VA)in the lesion;SMI vascular index(VI)technology to quantitatively analyze The percentage of microvessels in the lesion is quantified by the SMI vascular index(VI)technique,and the results of the lesion determination are compared with the pathological findings(undergoing a surgical treatment or puncture biopsy).To compare the diagnostic efficacy of 2D sonography,CDFI,and SMI techniques on the nature of breast lesions.The effect of different sizes of lesions on the diagnostic efficacy of each technique was analyzed in subgroups.To compare the diagnostic efficacy of 2D ultrasound,SMI,SMI-3D,and SMI-VI with that of 2D ultrasound alone and 2D ultrasound combined with SMI only,and to predict whether the addition of SMI-3D and SMI-VI can further complement 2D ultrasound and SMI and improve the diagnostic efficacy.Results:1 Pathological findingsOf the 100 BI-RADS-4 breast lesions included in the study,49 cases(49%)were pathologically confirmed benign lesions,mainly fibroadenoma,and mammary adenopathy,respectively,22 cases(22%)of fibroadenoma and 20 cases(20%)of mammary adenopathy,and 51 cases(51%)of malignant lesions,mainly invasive breast cancer,with 33 cases(33%).2 SMI diagnostic results for all breast lesions in this study2.1 SMI ultrasound performanceThe CDFI technique showed a total of 35(35%)lesions containing more than 3vessels and the SMI technique showed a total of 47(47%)lesions containing more than 3 vessels.The detection rate of the number of vessels was significantly better with the SMI technique than with the CDFI technique(P < 0.05)In 49 cases of benign breast lesions,there was no statistically significant difference between the two techniques in determining the results(P > 0.05).Among 51 cases of malignant breast lesions,31 cases were determined as malignant lesions using the CDFI technique,and 42 cases were determined as malignant lesions using the SMI-2D technique,and the difference between the two techniques was statistically significant(P < 0.05),and the detection rate of malignant breast lesions by SMI technique was significantly higher than that by CDFI technique.2.2 SMI-VI ultrasound performance resultsThe VI value of 4.1 was obtained as the cut-off value for benign and malignant breast lesions,and the results were obtained by grouping the cut-off values: the VI value of the malignant group(9.46±6.91)was higher than the VI value of benign lesions(3.48±3.76),VI <4.1,suggesting a high possibility of benign lesions,and VI≥4.1,suggesting a high possibility of malignant lesions;the sensitivity of SMI-VI technique for the diagnosis of benign and malignant breast lesions: 94.12%,specificity: 87.76%,Accuracy: 91.00%(P < 0.001,95% CI: 0.844-0.975);SMI-VI technique(AUC: 0.909)It indicates that VI values can be used to quantitatively assess the density of microvessels within the lesions,thus identifying the benign and malignant breast lesions with good diagnostic efficacy.2.3 SMI-3D ultrasound performance resultsThe SMI-3D technique detects that the blood flow pattern in the breast lesion shows: avascular,linear,and dendritic,suggesting a high possibility of benign lesions(positive predictive value PPV: 85.71%,91.30%,89.47%;negative predictive value NPV: 53.76%,63.64%,60.49%);the blood flow pattern shows: stump type,crab foot type,suggesting a high possibility of malignancy(PPV: 85.71%,95.65%;NPV:37.50%,37.66%).large(PPV: 85.71%,95.65%;NPV: 37.50%,37.66%).2.4 Diagnostic efficacy assessment of CDFI with SMI,SMI-VI,and SMI-3D techniques for benign and malignant breast lesionsCDFI technique for benign and malignant breast lesions(P < 0.001,Kappa:0.523,AUC: 0.763,95% CI: 0.667-0.859);SMI technique for benign and malignant breast lesions(P < 0.001,Kappa: 0.720,AUC: 0.861,95% CI: 0.782-0.939);SMI-3D technique for benign and malignant breast lesions(P < 0.001,Kappa: 0.800,AUC:0.900,95% CI: 0.832 to 0.968);SMI-VI technique for benign and malignant breast lesions(P < 0.001,Kappa: 0.820,AUC: 0.909,95% CI: 0.844 to 0.975),SMI-VI and SMI-3D were superior to SMI in diagnostic efficacy and better than CDFI technique.2.5 Combined diagnosis of SMI technologyTwo-dimensional ultrasound(2D-US)was combined with SMI,SMI-3D,and SMI-VI with a sensitivity of 96.08%,specificity of 95.92%,the accuracy of 96%,and AUC: 0.960,which complemented 2D-US with SMI to further improve the diagnostic efficacy.3 Results were obtained for different sizes of breast lesions3.1 SMI ultrasound performanceFor benign breast lesions >1 cm in diameter,there was no statistically significant difference between the two techniques of CDFI and SMI(P > 0.05);for malignant lesions,there was no statistically significant difference between the two techniques of CDFI and SMI(P > 0.05).For benign breast lesions ≤1 cm in diameter,the difference between CDFI and SMI techniques was not statistically significant(P > 0.05);for malignant lesions,the detection rate of the SMI technique was significantly higher than that of the CDFI technique(P < 0.05).The lesion diameter affected the detection ability of both CDFI and SMI techniques.With small lesions,the ability of CDFI and SMI techniques to detect microvessels within them was reduced to varying degrees compared with large lesions,but CDFI had little diagnostic power for small lesions(Kappa value of only 0.039),and SMI was in good agreement with pathological results(Kappa: 0.636).3.2 SMI-3D Ultrasound PerformanceThe SMI-3D technique detected that the blood flow frameworks within the breast lesions showed: avascular,dotted-line,and dendritic,suggesting a high possibility of benign lesions;the blood flow frameworks showed: stump type and crab foot type,suggesting a high possibility of malignancy.When the maximum diameter of the lesion was >1 cm,the PPV of avascular,dotted-line,and dendritic flow frames: 100.00%,83.33%,91.67%;NPV: 0.65%,68.63%,77.78%;PPV of the stump and crab foot type flow frames: 89.47%,94.44%,NPV: 50.00%,48.72%;Kappa: 0.810,AUC: 0.901.PPV for avascular,linear,and dendritic flow frames at maximum lesion diameter≤1 cm: 80.00%,94.11%,85.71%;NPV: 36.84%,53.85%,38.89%;PPV for stump and crab foot flow frames: 77.78%,100.00%;NPV: 23.53%,26.32%,and Kappa:0.740,AUC: 0.864.It indicates that the small size affects the observation of the blood flow conformation and slightly increases the rate of leakage of malignant lesions;the exclusion of benign lesions is also slightly diminished,but overall it is not significant and can maintain a strong consistency with the pathological findings.3.3 SMI-VI ultrasound performanceThe SMI-VI technique quantified the blood flow within the breast lesions,and4.1 was used as the differential diagnostic threshold for benign and malignant breast lesions.Sensitivity 97.22%,specificity 85.71%,accuracy 92.98%,(Kappa: 0.846,AUC:0.915)when the maximum diameter of the lesion was>1;Sensitivity 86.67%, specificity 89.29%,accuracy 88.37%,(Kappa: 0.748,AUC: 0.880)at the maximum diameter of lesion ≤1;It indicates that as the maximum diameter of the lesion decreases,the microvascular density also decreases,reducing the diagnostic ability,but it can maintain strong agreement with the pathological results(Kappa: 0.748).Conclusion:1 2D-US can rapidly identify breast BI-RADS-4 lesions,and both CDFI and SMI can provide more information on the differentiation of benign and malignant nature and improve the diagnostic efficacy.2 In terms of low-velocity microvessels in BI-RADS-4 lesions,SMI has a higher detection rate compared with CDFI.3 In terms of the malignant recognition rate of BI-RADS-4 lesions,SMI has a higher diagnostic value than CDFI.Adler 2 and 3 ratings of SMI,SMI-VI is higher than 4.1,and SMI-3D for stump and crab foot shape further improves the recognition rate of breast malignancy.4 2D-US and CDFI ultrasound combined with SMI,SMI-3D,and SMI-VI had higher sensitivity,specificity,and accuracy than the previous 2D-US combined with SMI,which further improved the diagnostic efficacy.5 In the diagnosis of small lesions,SMI has better diagnostic efficacy.