The Use of Breast Ultrasound Color Doppler Vascular Pattern Morphology Improves Diagnostic Sensitivity with Minimal Change in Specificity

 

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Zusammenfassung

Ziel: Ziel dieser Studie war es, herauszufinden, inwieweit die Verwendung der Gefäßmorphologie um und innerhalb einer anomalen B-Mode-Region von Nutzen ist, die diagnostische Genauigkeit bei 2 der häufigsten soliden Brustpathologien zu verbessern. Material und Methoden: Im Rahmen einer retrospektiven Studie wurden die B-Mode- und Doppler-Bilder von 117 Mammakarzinomen und 366 Fibrodadenomen und Fibroadenom-ähnlichen Läsionen untersucht. Beurteilt wurde dabei die Morphologie des Vaskularisationsmusters. Bei den Läsionen wurden der Quotient des Farbdopplerergebnis aus externen und internen Gefäßen, das externe Vaskularisationsmuster und die Verbindungsgefäße zu den internen Gefäßen untersucht und sodann eine Einteilung in benigne und maligne Vaskularisationsmuster vorgenommen. Diese Muster wurden wiederum mit dem histologischen Ergebnis korreliert. Ergebnisse: Ein Vaskularisationsnachweis gelang in 95 % der Karzinome und in 46 % der benignen Läsionen. Bei Karzinomen konnte ein Trend zu einer vermehrten Vaskularisation beobachtet werden. Dies führte bei Fibroadenomen beim Karzinomausschluss zu einer geringen Spezifität. Die Variationen der Vaskularisationsmuster wurden aufgezeichnet. Als benigne Vaskularisationsmuster wurden fehlende Vaskularität, Vaskularität in der Peripherie und periphere Grenzgefäße in Verbindung mit internen Gefäßen angesehen. Als maligne Gefäßmuster konnten radial ausgerichtete äußere Gefäße und ein Überwiegen von internen im Gegensatz zu externen Gefäßen, die mit den radialen Gefäßen in Verbindung standen, festgestellt werden (Fisher exact test p < 0,0001). Die Analyse der Vaskularisationsmorphologie verbesserte die Sensitivität, d. h. Karzinome zu identifizieren, von 97 % (B-Mode) auf 99 % (B-Mode und Farbdoppler), bei einem nur minimalen Rückgang der Spezifität (von 93,7 auf 92,6 %) oder der Genauigkeit (von 94,6 auf 94,2 %). Schlussfolgerung: Der Nachweis von Vaskularisation innerhalb von Läsionen kann für sich allein nicht mehr als guter Voraussageparameter gesehen werden, da der Anstieg der Dopplersensitivität mit Verbesserungen in der Ultraschalltechnologie einhergeht. Die morphologische Beurteilung des Gefäßmusters im Farbdoppler verbessert die Sensitivität der B-Mode-Diagnostik bei Mammakarzinomen und Fibroadenomen, wobei die Spezifität nur gering abnimmt. Im Vergleich zu den lediglich angrenzenden Gefäßen sollten alle radial angeordneten Verbindungsgefäße in einer Brustläsion als verdächtig eingestuft werden.

Abstract

Purpose: The aim of this study was to evaluate the use of vascular morphology, around and within the B-mode region of abnormality, for improving the diagnostic accuracy of two of the most common solid breast pathologies. Materials und Methods: The B-mode and Doppler images of 117 breast cancers and 366 fibroadenomas and lesions with a fibroadenoma-like appearance were reviewed retrospectively and the morphology of the vascular pattern was evaluated. The ratio of external to internal color Doppler, the external vascular pattern and the connecting vessels to internal vessels were assessed and differentiated into benign and malignant vascular patterns. These patterns were correlated with the histological diagnosis. Results: Vascularity was demonstrated in 95 % of cancers and in 46 % of benign lesions with a trend to increasing vascularity in cancers. This provided poor specificity for excluding cancer in fibroadenomas. Variations in vascular pattern were recorded. The observed benign vascular patterns were avascularity, vascularity in the periphery and peripheral marginal vessels connecting with internal vascularity. The observed malignant vascular patterns were radially aligned external vessels with internal vessels being more numerous than external vessels which connected to radial vessels. (Fisher exact test p < 0.0001). Analysis of the vascular morphology improved the sensitivity for identifying cancers from 97 % (B-mode) to 99 % (B-mode and color Doppler) with a minimal reduction in specificity (93.7 to 92.6 %) or accuracy (94.6 to 94.2 %). Conclusion: The presence of vascularity within a lesion, by itself, is no longer a good predictor of malignancy because of the increase in Doppler sensitivity associated with improvements in ultrasound technology. The color Doppler ultrasound vascular pattern morphology improves the accuracy and sensitivity of B-mode image diagnosis, breast cancers and fibroadenomas with a minimal loss of specificity. Any breast lesion with radial rather than marginal connecting vessels should be regarded with suspicion.

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Dr. William Edward Svensson

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