The Diagnostic Value Of Ultramicrovascular Imaging In Benign And Malignant Breast Lesions And Its Comparison With Pathology

ObjectiveTo study the vascular index(VI)cut-off value and vascular architecture(VA)of benign and malignant lesions by superb microvascular imaging(SMI).And to explore whether SMI can improve the diagnostic efficiency by evaluating VI and VA in breast lesions.Materials and methods:In this study,225 consecutive cases of breast lesions from November 2016 to December 2017 were used as the training set,the VI values and VA types of benign and malignant lesions were calculated based on the pathological results as the reference standard.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 by using the Delong method to compare the diagnostic efficacy of conventional ultrasound diagnosis alone and combined with SMI.ResultsAmong the 225 breast lesions in the training set,112 were malignant and 113 were benign.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).VI value of 4.05 was used as the diagnostic threshold for differentiating benign from malignant lesions,with the sensitivity of 80.5%,the specificity of 61.9%,the accuracy of 71.1%,PPV62.9%,NPV76.g%,and 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 VA were 93.9%and 100.0%,respectively.The NPV of the non-vascular,dot-linear and tree-like were 53.4%,69.O%and 51.3%,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(95%CI:0.719-0.844).The verification set of 238 lesions included 138 malignant lesions and 100 benign lesions.Conventional ultrasound combined with SMI diagnosis improved diagnostic specificity(70.0%vs.90.0%),accuracy(87.4%vs.96.6%),and PPV(82.5%vs.93.2%)without decreasing diagnostic sensitivity(99.3%).ConclusionVI value 4.05 is a cut-off value with good diagnostic efficacy.The hair-like and crab claw-like VA are the characteristic VA of malignant lesions,and the non-vascular,dot-linear and tree-like VA are the characteristic VA of benign lesions.SMI combined with VI and VA has a better diagnostic efficiency,which can improve the diagnostic specificity,accuracy and PPV without reducing the diagnostic sensitivity,contribute to reducing the unnecessary biopsy of benign lesions.ObjectiveTo apply SMI technology to quantitatively evaluate the blood supply of breast lesions by measuring the vascular index(VI value)of breast lesions,and compare the VI value with with histopathological microvessel density(MVD)to provide a pathological basis for the application of SMI technology quantitatively evaluating blood flow abundance.Materials and methods:Prospective study of 113 lesions from 113 patients in Peking Union Medical College Hospital from June to December 2018.All patients underwent SMI examination before operation to evaluate the vascular index(Vascular index,VI).All postoperative CD34 immunizations were performed histochemical detection of MVD expression,using Spearman correlation coefficient to study the correlation between VI value and MVD.ResultsOf the 113 breast lesions,72 were malignant(63.7%)and 41 were benign(36.3%).There was a significant difference in MVD expression between benign and malignant groups(t=-6.253,P<0.001).Spearman correlation coefficient rs=0.740 of VI value and MVD,P<0.001,indicating that VI value is positively correlated with MVD.The correlation between the VI value and MVD in the large lesion group(>1cm)was slightly stronger than that in the small lesion group(≤cm),but the VI value and MVD in both groups had a positive correlation.Conclusion:SMI technology can quantitatively evaluate the richness of blood vessels in lesions.This study showed that VI value was well correlated with MVD.As an emerging Doppler technology,SMI technology has good clinical application prospects.