Value of ContrastEnhanced Ultrasound in Differential Diagnosis of Benign and Malignant Breast Mass_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YOU Houcheng ¹ , LIU Jian ² , YOU Nan. ³

1.Department of Pharmacy, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;;
2.Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China;;
3.Department of Hepatobiliary Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China;

Corresponding author：

Keywords：

Contrast-enhanced ultrasonography; SonoVue; General ultrasound; Breast tumors; Differential diagnosis

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ObjectiveTo investigate the value of contrastenhanced ultrasonography in differential diagnosis between benign and malignant breast mass. MethodsTotally 65 patients with 70 breast masses were evaluated by general ultrasonography and contrastenhanced ultrasonography with contrast agent SonoVue. The related indexes, such as the degree and mode of contrast enhancement, the lesion boundaries and dissipation mode, were used to describe the difference between benign and malignant mass, which was also compared with pathological results. ResultsHistopathological examination revealed that benign mass was in 37 cases and malignant in 28 cases. The sensitivity, accuracy, positive predictive value, and negative predictive value of contrastenhanced ultrasonography with contrast agent SonoVue were significantly higher than that of general ultrasonography (P lt;0.05), while no significant difference in diagnostic specificity and misdiagnosis rate was observed between them (P gt;0.05). All tumors showed contrast enhancement in various degrees. Of 28 patients with enhanced mass, hyperenhancement in 22 cases and nodular inhomogeneous enhancement in 21 cases were observed and the boundaries of malignant tumor were irregular with ill-defined and radial enhancement. Most of benign tumors were represented by weak, homogeneous enhancement, and the shape was regular with smooth and tidy boundary and intact capsule except seven cases with unclear boundary. These imaging characteristics of benign and malignant tumors were obviously different (P=0.000). In the resolution phase, both benign and malignant mass showed heterogeneous or homogeneous dissipation, which was not significantly different (P=0.791). ConclusionCompared with general ultrasonography, contrast enhanced ultrasonography may be more helpful for the differential diagnosis of benign and malignant breast tumors.

Citation： YOU Houcheng,LIU Jian,YOU Nan.. Value of ContrastEnhanced Ultrasound in Differential Diagnosis of Benign and Malignant Breast Mass. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(8): 861-865. doi: Copy

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7.	Exacoustos C, Zupi E, Szabolcs B, et al. Contrasttuned imaging and secondgeneration contrast agent sonovue: a new ultrasound approach to evaluation of tubal patency [J]. J Minim Invasive Gynecol, 2009, 16(4): 437444.
8.	汪勇，程蕊，王晓飞，等．超声造影剂—SonoVue的技术回顾 [J]．中华临床医学研究杂志， 2006， 12（12）： 16751677．.
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25.	方华，李凤华，夏建国，等．实时灰阶超声造影在乳腺肿瘤诊断中的应用研究 [J]．中国超声医学杂志， 2007， 23（6）： 423425．.
26.	Yang WT, Tse GM, Lam PK, et al. Correlation between color power doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis [J]. J Ultrasound Med, 2002, 21(11): 12271235.

1. Dǎnilǎ M, Popescu A, Sirli R, et al. Contrast enhanced ultrasound (CEUS) in the evaluation of liver metastases [J]. Med Ultrason, 2010, 12(3): 233237.
2. Badea R, Socaciu M, Ciobanu L, et al. Contrastenhanced ultrasonography (CEUS) for the evaluation of the inflammation of the digestive tract wall [J]. J Gastrointestin Liver Dis, 2010, 19(4): 439444.
3. Kim TK, Lee KH, Khalili K, et al. Hepatocellular nodules in liver cirrhosis: contrastenhanced ultrasound [J]. Abdom Imaging, 2011, 36(3): 244263.
4. Ooi CC, Low SC, Schneiderkolsky M, et al. Diagnostic accuracy of contrastenhanced ultrasound in differentiating benign and malignant focal liver lesions: a retrospective study [J]. J Med Imaging Radiat Oncol, 2010, 54(5): 421430.
5. Von HA, Vogt C, Westendorff J, et al. Correlation between sonovue enhancement in CEUS, HCC differentiation and HCC diameter: analysis of 130 patients with hepatocellular carcinoma(HCC) [J]. Ultraschall Med, 2009, 30(6): 544550.
6. Von HA, Westendorff J, Gregor M. Contrastenhanced ultrasound with sonovue: differentiation between benign and malignant focal liver lesions in 317 patients [J]. J Clin Ultrasound, 2010, 38(1): 19.
7. Exacoustos C, Zupi E, Szabolcs B, et al. Contrasttuned imaging and secondgeneration contrast agent sonovue: a new ultrasound approach to evaluation of tubal patency [J]. J Minim Invasive Gynecol, 2009, 16(4): 437444.
8. 汪勇，程蕊，王晓飞，等．超声造影剂—SonoVue的技术回顾 [J]．中华临床医学研究杂志， 2006， 12（12）： 16751677．.
9. 邵志敏，余科达．乳腺外科的发展趋势 [J]．中国普外基础与临床杂志， 2007， 14（3）： 252254．.
10. Rezo A, Dahlstrom J, Shadbolt B, et al. Tumor size and survival in multicentric and multifocal breast cancer [J]. Breast, 2011, 20(3): 259263.
11. 张淑琴，胡欣，李洪娥，等． 3种影像学技术和血清标志物对乳腺癌诊断的价值 [J]．放射免疫学杂志， 2009， 22（6）： 589591．.
12. 吕珂，张缙熙，傅先水．彩色多普勒超声对乳腺良恶性病变鉴别的价值 [J]．中国超声医学杂志， 1998， 14（5）： 6769．.
13. 秦茜淼，华秀云，潘永辉．彩色多普勒血流显像对乳腺癌的诊断价值 [J]．中国医学影像技术， 1998， 14（1）： 5153．.
14. Feige JJ. Tumor angiogenesis: recent progress and remaining challenges [J]. Bull Cancer, 2010, 97(11): 13051310.
15. Derleth C, Mayer IA. Antiangiogenic therapies in earlystage breast cancer [J]. Clin Breast Cancer, 2010, 10(Suppl 1): E23E31.
16. Specht JM, Kurland BF, Montgomery SK, et al. Tumor metabolism and blood flow as assessed by positron emission tomography varies by tumor subtype in locally advanced breast cancer [J]. Clin Cancer Res, 2010, 16(10): 28032810.
17. 雷成功，郭艳琴．乳腺良恶性肿瘤的超声诊断价值 [J]．实用医技杂志， 2010， 17（2）： 103104．.
18. 黄丽萍，解丽梅，唐少珊，等．实时超声造影对肝脏恶性肿瘤鉴别诊断的应用研究 [J]．中国超声医学杂志， 2007， 23（2）： 134136．.
19. 朱庆莉，姜玉新．超声造影在乳腺肿瘤诊断中的应用 [J]．中国医学影像技术， 2003， 19（10）： 14041406．.
20. Lassau N, Chami L, Chebil M, et al. Dynamic contrastenhanced ultrasonography (DCEus) and antiangiogenic treatments [J]. Discov Med, 2011, 11(56): 1824.
21. Schneider M. Contrast media in ultrasonography: from synthesis to clinical use.the sonovue example [J]. Ann Cardiol Angeiol, 2002, 51(4): 218220.
22. Foster FS, Burns PN, Simpson DH, et al. Ultrasound for the visualization and quantification of tumor microcirculation [J]. Cancer Metastasis Rev, 2000, 19(12): 131138.
23. Jung EM, Jungius KP, Rupp N, et al. Contrast enhanced harmonic ultrasound for differentiating breast tumorsfirst results [J]. Clin Hemorheol Microcirc, 2005, 33(2): 109120.
24. Ricci P, Cantisani V, Ballesio L, et al. Benign and malignant breast lesions: efficacy of real time contrastenhanced ultrasound vs. magnetic resonance imaging [J]. Ultraschall Med, 2007, 28(1): 5762.
25. 方华，李凤华，夏建国，等．实时灰阶超声造影在乳腺肿瘤诊断中的应用研究 [J]．中国超声医学杂志， 2007， 23（6）： 423425．.
26. Yang WT, Tse GM, Lam PK, et al. Correlation between color power doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis [J]. J Ultrasound Med, 2002, 21(11): 12271235.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of ContrastEnhanced Ultrasound in Differential Diagnosis of Benign and Malignant Breast Mass

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