Diagnostic Performance of Superb Microvascular Imaging (SMI) Combined with Shear-Wave Elastography in Evaluating Breast Lesions

Zhu, Yicheng; Zhang, Yuan; Deng, Shuhao; Jiang, Quan

doi:10.12659/msm.910399

Cited by 37 publications

(44 citation statements)

References 20 publications

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“…Regarding the color Doppler image, there are several studies showing that combined elastography and color Doppler images improves diagnostic performance (28,29,(32)(33)(34). Most of the previous studies investigating SMI used qualitative features or subjective Adler's grading of vascularity (32,(35)(36)(37)(38)(39). Recently, the quantitative assessment of SMI has become available by calculating the ratio of Doppler signals within the lesion, called the vascular index.…”

Section: Discussionmentioning

confidence: 99%

Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses

Lee

Chang

2020

Korean J Radiol

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This study aimed to evaluate the diagnostic value of combining the quantitative parameters of shear wave elastography (SWE) and superb microvascular imaging (SMI) to breast ultrasound (US) to differentiate between benign and malignant breast masses. Materials and Methods: A total of 200 pathologically confirmed breast lesions in 192 patients were retrospectively reviewed using breast US with B-mode imaging, SWE, and SMI. Breast masses were assessed based on the breast imaging reporting and data system (BI-RADS) and quantitative parameters using the maximum elasticity (Emax) and ratio (Eratio) in SWE and the vascular index in SMI (SMIVI). The area under the receiver operating characteristic curve (AUC) value, sensitivity, specificity, accuracy, negative predictive value, and positive predictive value of B-mode alone versus the combination of B-mode US with SWE or SMI of both parameters in differentiating between benign and malignant breast masses was compared, respectively. Hypothetical performances of selective downgrading of BI-RADS category 4a (set 1) and both upgrading of category 3 and downgrading of category 4a (set 2) were calculated. Results: Emax with a cutoff value of 86.45 kPa had the highest AUC value compared to Eratio of 3.57 or SMIVI of 3.35%. In set 1, the combination of B-mode with Emax or SMIVI had a significantly higher AUC value (0.829 and 0.778, respectively) than B-mode alone (0.719) (p < 0.001 and p = 0.047, respectively). B-mode US with the addition of Emax, Eratio, and SMIVI had the best diagnostic performance of AUC value (0.849). The accuracy and specificity increased significantly from 68.0% to 84.0% (p < 0.001) and from 46.1% to 79.1% (p < 0.001), respectively, and the sensitivity decreased from 97.6% to 90.6% without statistical loss (p = 0.199). Conclusion: Combining all quantitative values of SWE and SMI with B-mode US improved the diagnostic performance in differentiating between benign and malignant breast lesions.

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Section: Discussionmentioning

confidence: 99%

Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses

Lee

Chang

2020

Korean J Radiol

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“…SMI eliminates the clutter and presents more real blood flow information, which provides a more accurate vascular situation of the masses than CDFI. 14,21 This method can be used as a quantitative guide by measuring VI for breast in the optimal SMI plane with the most abundant vessels. In our study, BI-RADS 4 lesions were downgraded one level (4A-3, 4B-A, 4C-4B) with 4.0 as the cutoff value of VI, the diagnostic accuracy (65.3% vs 41.9%), PPV (54.8% vs 41.9%) and AUC (0.700 vs 0.500, p < 0.001) were improved, highlighting a potential decrease in the number of biopsies and surgeries with negative findings.…”

Section: Discussionmentioning

confidence: 99%

<p>The Vascular Index of Superb Microvascular Imaging Can Improve the Diagnostic Accuracy for Breast Imaging Reporting and Data System Category 4 Breast Lesions</p>

Cai¹,

Wang²,

Zhang³

et al. 2020

CMAR

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Purpose: To investigate whether the vascular index (VI) of superb microvascular imaging (SMI) could improve the diagnostic efficiency for BI-RADS 4 breast lesions and reduce the number of unnecessary biopsies. Patients and Methods: For this study, we selected 222 consecutive BI-RADS 4 breast lesions detected by ultrasound and confirmed by pathology from January 2016 to October 2018. AVI of 4.0 was set as the cutoff value to degrade BI-RADS classification. We calculated the accuracy, sensitivity and PPVof a BI-RADS diagnosis alone and the combination of BI-RADS and the VI. Results: Pathologically, of the 222 lesions, 129 were confirmed to be benign, and 93 were found to be malignant. AVI of 4.0 was set as the cutoff value; when the VI≤4.0, those BI-RADS 4 masses were downgraded one level (4C-4B, 4B-4A, 4A-3) to an integral BI-RADS grade, while the others maintained the conventional grade. A total of 54 BI-RADS 4 lesions were degraded to BI-RADS 3, including 53 benign lesions and 1 malignant lesion. The diagnostic accuracy (65.3% vs 41.9%) and PPV (54.8% vs 41.9%) were significantly improved. The sensitivity decreased slightly (98.9% vs 100%) because 1 of the 54 downgraded BI-RADS 4 lesions, which had a pathological type of invasive ductal carcinoma, was incorrectly downgraded. Conclusion: SMI is a noninvasive tool for visualizing the vascular structure with highresolution microvascular images. As a quantitative index, the VI can be used to appropriately downgrade benign lesions classified as BI-RADS 4, which can improve the diagnostic accuracy and PPV and reduce unnecessary biopsies.

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“…Ultrasound imaging is important for screening patients for breast cancer. In recent years, the broad use of the Breast Imaging Reporting and Data System (BI-RADS) [3] for conventional ultrasonography has improved the predictive value of breast cancer diagnosis. The BI-RADS is primarily based on a subjective judgment by clinicians; thus, conventional ultrasound diagnosis remains imperfect [4][5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules

Shen

Liu

et al. 2020

Preprint

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Background: Identification of malignancy in small breast nodules can be difficult using conventional methods, especially in patients with dense breast tissue. Advanced imaging techniques, including contrast-enhanced ultrasound (CEUS) and shear-wave elastography (SWE), could be used in conjunction with Breast Imaging Reporting and Data System (BI-RADS) classification to characterize these nodules more effectively. This study aimed to evaluate the use of CEUS and SWE for the differentiation of benign from malignant small (≤ 2 cm) breast nodules.Methods: This retrospective study reviewed the medical records and imaging data of 302 patients who underwent evaluation for 305 small breast nodules from November 2015 to December 2019. BI-RADS classification of nodules and the results of CEUS and SWE were retrospectively analyzed; the diagnostic efficacy of these techniques was evaluated by comparison with pathology results. Receiver operating characteristic curves were analyzed based on the CEUS patterns and shear-wave velocity values of nodules. The sensitivities, specificities, positive and negative predictive values, and accuracies of BI-RADS, CEUS, SWE, and a combination of all three methods for identifying benign versus malignant small breast nodules were investigated.Results: CEUS was effective at diagnosing malignant nodules when at least two out of nine suspicious features were present. Receiver operating curve analysis revealed that the best cut-off value for SWE was 3.7 m/s. For the diagnosis of benign breast nodules, the BI-RADS classification was reduced by one level when both CEUS and SWE were used, and was unchanged when either CEUS or SWE alone were used; the highest and lowest levels were category 5 and 3, respectively. Furthermore, when using the combined method, 75.8% (91/120) of small breast nodules with a BI-RADS category 4A classification avoided the need for coarse needle biopsies.Conclusion: Both CEUS and SWE can be used as auxiliary methods for clarifying BI-RADS classification of breast nodules, and a combination of these techniques may provide more diagnostic efficacy for identifying malignancy in small breast nodules.

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Diagnostic Performance of Superb Microvascular Imaging (SMI) Combined with Shear-Wave Elastography in Evaluating Breast Lesions

Cited by 37 publications

References 20 publications

Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses

Combination of Quantitative Parameters of Shear Wave Elastography and Superb Microvascular Imaging to Evaluate Breast Masses

<p>The Vascular Index of Superb Microvascular Imaging Can Improve the Diagnostic Accuracy for Breast Imaging Reporting and Data System Category 4 Breast Lesions</p>

Efficacy of contrast-enhanced ultrasonography and shear-wave elastography in conjunction with BI-RADS classification for diagnosis of small breast nodules

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