Differentiation between benign and malignant breast tumors using kinetic features of real-time harmonic contrast-enhanced ultrasound

Abstract

Background Contrast-enhanced ultrasound (CEUS) has gained interest because of its ability to gather vascular information in diverse organs. There is still a subject of debate concerning its value in breast lesions, especially as a differential diagnostic tool. Purpose To investigate whether kinetic parameters of CEUS can differentiate between malignant and benign breast lesions. Material and Methods We evaluated 75 malignant and 21 benign lesions in the breast or axilla. Contrast harmonic imaging (CHI) US was performed after the injection of a bolus dose of 2.4 mL of Sono Vue® (Bracco, Milano, Italy). The following parameters were calculated for kinetic analysis: initial slope, time to peak enhancement, wash-out ratios W21 and W50 (relative decrease in signal intensity from the peak enhancement to 21 s and 50 s, respectively). Results A significant difference was found between the benign and malignant lesions in time-to-peak ( P value <0.05) and wash-out ratios W21 ( P value <0.001) and W50 ( P value <0.001). The mean time-to-peak was 9.3 s for malignant and 14.6 s for benign lesions. The mean signal drop from peak to signal intensity measured at 50 s was 85% for malignant and 66% for benign lesions. There was no difference in absolute values of peak signal intensity and initial slope. The most significant difference between standardized benign and malignant wash-out curves was found at 21 s but statistical significance was reached in the range of 14–50 s. Conclusion Real-time CEUS can evolve into a new non-invasive option for differentiate malignant from benign breast lesions.

Papillary breast lesions on contrast-enhanced ultrasound: morphological enhancement patterns and diagnostic strategy

“…Saracco et al analysed the enhancement kinetics of 96 breast tumours. They found that signal drop from peak to the intensity measured at 50 s was significantly greater in malignant tumours compared to benign lesions [15]. The pathophysiology behind the two observed morphological wash-out patterns remains speculative.…”

“…In addition, with the implementation of high-frequency probes, the spatial resolution of contrast imaging is significantly improved; thus, a greater number of details can be acquired for morphological assessment. Although several studies show that CEUS detects breast tumours [14][15][16], to the best of our knowledge, the enhancement features of papillary lesions have not yet been reported. Further, there is little information regarding the comparison of these breast abnormalities with other benign lesions that mimic papillary lesions.…”

Optimization of Region of Interest Drawing for Quantitative Analysis

“…Various quantitative parameters were significant for differentiating between malignant and benign lesions in kinetic curve analysis using dynamic contrast-enhanced breast magnetic resonance imaging, including wash-out ratio. [16][17][18][19] However, only 1 previous report 14 suggested that Receiver operating characteristic curve analysis of a 15-mm circular ROI for the peak signal intensity, time to peak, and initial slope showing diagnostic accuracy in differentiation between benign and malignant breast lesions. Abbreviations are as in Table 1. the wash-out ratio was significant on contrast-enhanced breast sonography.…”

“…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).…”

Contrast-Enhanced Ultrasound with Perflubutane in the Assessment of Anti-Angiogenic Effects: Early Prediction of the Anticancer Activity of Bevacizumab in a Mouse Xenografted Model

“…Liver and breast lesions can be characterized by tumor vasculature and perfusion, which are visualized with perflubutane (Hatanaka et al 2008;Luo et al 2009;Miyamoto et al 2012Miyamoto et al , 2014 as well as with other micro-bubbles (Berry and Sidhu 2006;Saracco et al 2012). As the microbubbles distribute in the micro-circulation of the whole body (Toft et al 2006), it is expected that they will be applicable for imaging tumors in other organs and is known to be stable enough in vivo for the duration of the ultrasound examination (Marelli 2000).…”