Application Value Of Superb Microvascular Imaging In Breast Mass And Its Related Pathological Study

Objective: To investigate the value of conventional two-dimensional ultrasound combined with superb microvascular imaging(SMI)for the diagnosis of breast masses.To investigate the relationship between vascular index(Ⅵ)and pathological microvessel density(MVD)and immunohistochemical factors.Methods: 204 breast masses were collected from January 2021 to July 2022 in 172 consecutive patients at the First Hospital of China Medical University,and ultrasound and SMI images of breast masses were collected preoperatively,and all histological diagnoses were made using histopathological findings as the gold standard for diagnosis.There were 99 malignant breast lesions(mean age 54.82±10.07 years,range 33-78 years)and 105 benign breast lesions(mean age 43.06±11.25 years,range21-67 years).Using an Aplio i900(Superb microvascular imaging,Canon Medical Systems LTD,Japan)ultrasound diagnostic instrument,patients first underwent routine ultrasound examination of the breast and completed BI-RADS classification,followed by SMI imaging,and Ⅵ values were obtained by tracing the extent of the lesions.At the same time,a qualitative typing study was performed on the vascular distribution and travel characteristics of SMI images to evaluate the diagnostic value of the combined diagnostic methods of conventional ultrasound and SMI.The diagnostic efficacy of the combined methods was evaluated by comparing the area under the curve using chi-square test and ROC curve analysis.In addition,Pearson’s correlation analysis was performed between Ⅵ values and microvascular density(MVD)and immunohistochemical Ki-67 indexes in patients with malignant breast masses;t-test analysis was performed between Ⅵ values and immunohistochemical results of ER,PR and HER-2.Results: 1.The Ⅵ values of malignant breast tumors(11.37% ± 6.79%)were significantly higher than those of benign masses(5.31% ± 4.90%)(P < 0.05).The best cut-off value of Ⅵ for quantitative diagnosis of SMI was calculated by ROC analysis as 5.43%(sensitivity 80.81%,specificity 67.62%,accuracy 74.02%,AUC = 0.80).The SMI images were qualitatively analyzed and classified into six types,namely "no blood flow type","peripheral dotted bar type","surround type","internal dotted bar type",and "internal dotted bar type".The differences in the distribution of benign and malignant breast tumors among these types were statistically significant,among which "penetrating type" and "diffuse type" were the most important.The diagnostic efficacy of "penetrating type" and "diffuse type" in diagnosing malignancy was the best(sensitivity 78.78%,specificity 86.67%,accuracy 82.84%,AUC=0.859).The quantitative and qualitative diagnostic value of SMI alone was inferior to that of conventional ultrasound(sensitivity 79.80%,specificity 88.57%,accuracy 84.31%,AUC=0.914).The diagnostic values of conventional ultrasound combined with SMI quantitative diagnosis(P=0.047),conventional ultrasound combined with SMI qualitative diagnosis(P=0.003),conventional ultrasound tandem(P=0.003)and parallel(P=0.035)SMI qualitative and quantitative were all superior to conventional ultrasound for the diagnosis of breast lesions,with the highest diagnostic efficacy and accuracy of conventional ultrasound combined with SMI qualitative diagnosis(AUC=0.960,88.73% accuracy);2.Ⅵ values had a significant positive correlation with neovascularization of breast tumors,r=0.643(P<0.05);3.Ⅵ values were positively correlated with immunohistochemical index Ki-67 parameters,r=0.457(P<0.05);4.Ⅵ values of ER-negative breast masses were higher than those of ER-positive group(P= 0.031 < 0.05);no significant differences were seen between PR-negative and PR-positive and Her-2-negative and Her-positive Ⅵ values.Conclusions: 1.The Ⅵ values of malignant breast masses were significantly higher than those of benign breast masses;2.The value of using SMI alone for qualitative or quantitative diagnosis is less than that of conventional ultrasound,but conventional ultrasound combined with qualitative analysis of SMI can improve the diagnostic efficacy of breast tumors;3.The Ⅵ value of breast masses is positively correlated with MVD;4.The Ⅵ value of malignant breast masses correlated with the negative status of ER and high Ki-67 expression.