Differentiating benign from malignant solid breast lesions: Combined utility of conventional ultrasound and contrast-enhanced ultrasound in comparison with magnetic resonance imaging

Comparative Study of Contrast-Enhanced Ultrasound Qualitative and Quantitative Analysis for Identifying Benign and Malignant Breast Tumor Lumps

“…The results of this study showed that six indicators of qualitative analysis exhibited the differences in the benign and malignant groups, which reflected that the malignant breast tumor lumps were often rapid perfused, with heterogeneous enhancement, when reaching the peak, they exhibited the high enhancement and expanded diameters, the borders were not clear, and the edges would exhibit the feature of radial enhancement; while the benign tumor exhibited the slow perfusion progress, homogeneous enhancement, equal or low enhancement when reaching the peak, clear boundary, non-expanded diameter, and no radial enhanced edge. the multivariate analysis revealed that the enhanced homogeneity, expanded diameter or not, as well as the peak intensity grade were the main factors, and the enhanced homogeneity were the most prominent factor, indicating that the enhanced homogeneity would play the most role in determining the benign and malignant tumors, similar to the previous studies (Caproni et al, 2010;Zhao et al, 2010;Du et al, 2012). The relative pathophysiological basis lied in that the tumor cells would often secrete a large number of vascular endothelial growth factor (VEGF), thus generating a large number of fresh tiny blood vessels, but due to the vigorous growth of malignant cells, the tiny blood vessels could not supply the sufficient nutrients needed by the tumor cells, so the tumors would occur the internal necrosis, furthermore, the metastasis of tumor cells would often block these new blood vessels, further causing the tumor internal ischemia (Metz et al, 2003;Du et al, 2008), followed by the appearance of uneven distribution or filling defect of contrast agent inside the malignant tumors.…”

“…The relative pathophysiological basis lied in that the tumor cells would often secrete a large number of vascular endothelial growth factor (VEGF), thus generating a large number of fresh tiny blood vessels, but due to the vigorous growth of malignant cells, the tiny blood vessels could not supply the sufficient nutrients needed by the tumor cells, so the tumors would occur the internal necrosis, furthermore, the metastasis of tumor cells would often block these new blood vessels, further causing the tumor internal ischemia (Metz et al, 2003;Du et al, 2008), followed by the appearance of uneven distribution or filling defect of contrast agent inside the malignant tumors. Du et al ( 2012) studied and indicated that the characteristic of filling-defected regions within the lesions exhibited the high specificity towards the diagnosis of breast cancer, and this study still classified the characteristics of filling defect into the features of inhomogeneous enhancement, whether the diagnostic specificity was the highest still needed the further analysis. In addition, the malignant tumors often appeared the characteristics of enhanced posterior diameter expansion and high peak intensity.…”

“…The qualitative analysis is to assess the contrast enhancement patterns of breast lesions, which has the examiner-dependent accuracy. Several studies have shown that CEUS could provide the characteristic enhancement patterns that could be helpful in the differential diagnosis of breast lesions (Zhao et al, 2010;Du et al, 2012). CEUS quantitative parameters are obtained from time-intensity (T/I) curve using dedicated software, which offers an objective and reproducible assessment of lesion vascularisation.…”

Optimization of Region of Interest Drawing for Quantitative Analysis

“…In 1 previous report, the positive enhancement integral (regional blood volume) at 90 seconds on contrastenhanced breast sonography was significant for differentiating between malignant and benign lesions. 13 Our study had some limitations. First, the number of patients with benign lesions was small; therefore, further studies in larger populations are required to confirm the results.…”

“…However, the methods of ROI selection varied between studies, and previous reports have not discussed appropriate ROI selection. [10][11][12][13][14] This study was performed to investigate whether there are significant differences in kinetic parameters between benign and malignant breast lesions using different ROIs based on raw data from the same contrast-enhanced breast sonographic examinations. To our knowledge, this study is the first quantitative analysis of breast contrast-enhanced sonography using the perflubutane-based contrast agent Sonazoid, and the results were compared with previous quantitative studies using another second-generation contrast agent (SonoVue).…”