Reproducibility and diagnostic performance of the vascular index of superb microvascular imaging in real-time breast ultrasonography for evaluating breast masses

Lee, Eun Ji; Chang, Yun Woo; Oh, Eunsun; Hwang, Jiyoung; Kim, Hyun-joo; Hong, Seong Sook

doi:10.14366/usg.20153

Cited by 24 publications

(35 citation statements)

References 22 publications

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“…According to a meta-analysis study of adding SWE to B-mode US for the detection of breast cancer, SWE with B-mode US significantly improved specificity in differentiating between benign and malignant lesions and reduces the unnecessary biopsies of the patient having benign lesions 7 . A study on the combined use of the SMI vascular index and B-mode US, a recently introduced quantitative parameter, also showed improved diagnostic performance in distinguishing benign and malignant breast lesions compared to B-mode alone, without a significant change in sensitivity 15 , 16 .…”

Section: Discussionmentioning

confidence: 97%

“…There is no standardized cutoff value for SWE, and the cutoff values in previous studies varied over a wide range of 45.1–124.9 kPa for Emax and 3.56–5.14 for SWEratio 7 , 9 , 20 – 24 . The previously reported cutoff values of SMI VI ranged from 2.95 to 8.9% 4 , 15 , 16 , 18 , 25 , and were not measured in real-time US in most of the studies because the SMI VI measurements were obtained using post-processing software of the acquired images 4 , 15 , 25 . The relatively wide range of cutoff values is probably due to the characteristics of breast lesions such as lesion size, the histological malignancy type, overlapping features between benign and malignant lesions.…”

Section: Discussionmentioning

confidence: 99%

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Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters

Lee

Chang

2022

Sci Rep

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To investigate the diagnostic value of combined SWE, SMI, and B-mode US scores for distinguishing between benign and malignant masses. A total of 450 breast masses that underwent US-guided core needle biopsies were prospectively enrolled. The breast masses were assessed based on the BI-RADS and quantitative SWE and SMI parameters. The SWEmax, SWEratio, and SMIVI cutoff value were determined using Youden’s index by comparison to the pathological results. The BI-RADS categories were scored on a scale from 1 to 5, and SWEmax, SWEratio, and SMIVI were dichotomized based on each cutoff values (0 or 1). The combined scores (1 to 8) were calculated as the sum of the BI-RADS score and the quantitative scores and compared to the pathologic results using AUROC analysis. The cutoff values were 52.25 kPa for SWEmax, 5.03 for SWEratio, and 2.15% for SMIVI. In AUROC, the combined scores showed significantly better diagnostic performance compared to BI-RADS alone (p < 0.001). The combined score showed significantly increased than BI-RADS alone in specificity (p < 0.001) and accuracy (p < 0.001), but a sensitivity decreased without significance (p = 0.082). When a combined score cutoff value of 4 was used, the false negative rate was 2.7%. Using the combined score, 76.4% of the C4a lesions were considered benign also pathologically diagnosed as benign. The combined scores showed improved diagnostic performance in differentiating between benign and malignant breast masses, which could be helpful for determining a breast biopsy eligibility.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters

Lee

Chang

2022

Sci Rep

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“…Some studies have shown that the epidemiology, risk factors, and tumor characteristics of breast cancer in China differ from those in Korea and other Asian countries [ 27 , 28 , 29 ]. In addition, VI is a quantitative diagnostic criteria with low operator dependence, whereas AC, PV and MVDP are qualitative diagnostic criteria with relatively high operator dependence [ 30 ]. Based on the country, diagnosis criteria, and study design, meta-regression and subgroup analysis were conducted to investigate the sources of heterogeneity.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Value of Superb Microvascular Imaging in Differentiating Benign and Malignant Breast Tumors: A Systematic Review and Meta-Analysis

Feng

Jin

et al. 2022

Diagnostics

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Purpose: We performed a systematic review and meta-analysis of studies that investigated the diagnostic performance of Superb Microvascular Imaging (SMI) in differentiating between benign and malignant breast tumors. Methods: Studies published between January 2010 and March 2022 were retrieved by online literature search conducted in PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine Disc, China National Knowledge Infrastructure, Wanfang, and Vip databases. Pooled sensitivity, specificity, and diagnostic odd ratios were calculated using Stata software 15.0. Heterogeneity among the included studies was assessed using I2 statistic and Q test. Meta-regression and subgroup analyses were conducted to investigate potential sources of heterogeneity. Influence analysis was conducted to determine the robustness of the pooled conclusions. Deeks’ funnel plot asymmetry test was performed to assess publication bias. A summary receiver operating characteristic curve (SROC) was constructed. Results: Twenty-three studies involving 2749 breast lesions were included in our meta-analysis. The pooled sensitivity and specificity were 0.80 (95% confidence interval [CI], 0.77–0.84, inconsistency index [I2] = 28.32%) and 0.84 (95% CI, 0.79–0.88, I2 = 89.36%), respectively. The pooled diagnostic odds ratio was 19.95 (95% CI, 14.84–26.82). The area under the SROC (AUC) was 0.85 (95% CI, 0.81–0.87). Conclusion: SMI has a relatively high sensitivity, specificity, and accuracy for differentiating between benign and malignant breast lesions. It represents a promising supplementary technique for the diagnosis of breast neoplasms.

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“…Increased microvessel proliferation, an indicator of angiogenesis, was significantly correlated with negative ER status and basal-like phenotype in breast cancer ( 12 – 15 ). Previous studies showed that VI values of malignant breast lesions were significantly higher than those in benign breast lesions, and the combination of VI values with conventional B-mode US can enhance the diagnostic performance in differentiating benign from malignant breast masses ( 11 , 16 – 19 ). However, the correlation between VI measured by SMI and the molecular subtypes in invasive breast cancer and the performance of VI for prediction of molecular subtypes in invasive breast cancer has not been investigated.…”

Section: Introductionmentioning

confidence: 97%

“…VI was defined as the ratio of Doppler signal pixels to pixels in the total lesion measured via SMI. VI measured via SMI was a highly reproducible and objective quantitative parameter to estimate the degree of vascularity in breast lesions ( 11 ). Increased microvessel proliferation, an indicator of angiogenesis, was significantly correlated with negative ER status and basal-like phenotype in breast cancer ( 12 – 15 ).…”

Section: Introductionmentioning

confidence: 99%

Association Between Vascular Index Measured via Superb Microvascular Imaging and Molecular Subtype of Breast Cancer

et al. 2022

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BackgroundTo determine whether vascular index (VI; defined as the ratio of Doppler signal pixels to pixels in the total lesion) measured via superb microvascular imaging in breast cancer correlates with immunohistochemically defined subtype and is able to predict molecular subtypes.MethodsThis prospective study involved 225 patients with 225 mass-type invasive breast cancers (mean size 2.6 ± 1.4 cm, range 0.4~5.9 cm) who underwent ultrasound and superb microvascular imaging (SMI) at Peking Union Medical College Hospital before breast surgery from December 2016 to June 2018. The correlations between primary tumor VI measured via SMI, clinicopathological findings, and molecular subtype were analyzed. The performance of VI for prediction of molecular subtypes in invasive breast cancer was investigated.ResultsThe median VI of the 225 tumors was 7.3% (4.2%~11.8%) (range 0%~54.4%). Among the subtypes of the 225 tumors, 41 (18.2%) were luminal A, 91 (40.4%) were luminal B human epidermal growth factor receptor-2 (HER-2)-negative, 26 (11.6%) were luminal B HER-2-positive, 17 (7.6%) were HER-2-positive, and 50 (22.2%) were triple-negative, and the corresponding median VI values were 5.9% (2.6%~11.6%) (range 0%~47.1%), 7.3 (4.4%~10.5%) (range 0%~29.5%), 6.3% (3.9%~11.3%) (range 0.6%~22.2%), 8.2% (4.9%~15.6%) (range 0.9%~54.4%), and 9.2% (5.1%~15.3%) (range 0.7%~32.9%), respectively. Estrogen receptor (ER) negativity, higher tumor grade, and higher Ki-67 index (≥20%) were significantly associated with a higher VI value. Tumor size, ER status, and Ki-67 index were shown to independently influence VI. A cutoff value of 4.1% yielded 79.9% sensitivity and 41.5% specificity with an area under the receiver operating characteristic curve (AUC) of 0.58 for predicting that a tumor was of the luminal A subtype. A cutoff value of 16.4% yielded 30.0% sensitivity and 90.3% specificity with an AUC of 0.60 for predicting a triple-negative subtype.ConclusionsVI, as a quantitative index obtained by SMI examination, could reflect histologic vascular changes in invasive breast cancer and was found to be higher in more biologically aggressive breast tumors. VI shows a certain degree of correlation with the molecular subtype of invasive breast cancer and plays a limited role in predicting the luminal A with high sensitivity and triple-negative subtype with high specificity.

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Reproducibility and diagnostic performance of the vascular index of superb microvascular imaging in real-time breast ultrasonography for evaluating breast masses

Cited by 24 publications

References 22 publications

Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters

Prospective analysis of breast masses using the combined score for quantitative ultrasonography parameters

Diagnostic Value of Superb Microvascular Imaging in Differentiating Benign and Malignant Breast Tumors: A Systematic Review and Meta-Analysis

Association Between Vascular Index Measured via Superb Microvascular Imaging and Molecular Subtype of Breast Cancer

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