A Prospective Study of the Value of Ultrasound Microflow Evaluation to Distinguish Malignant from Benign Solid Breast Masses: Association between Ultrasound Parameters and Histologic Microvessel Density
유방 종괴에서 양악성 감별에서의 초음파의 미세혈류 측정의 유용성에 대한 전향적 연구 : 초음파 지표와 병리학적 미세혈류 밀도와의 연관성
- 주제(키워드) Ultrasonography , Doppler , Breast neoplasm , Microvessels , Contrast media
- 발행기관 고려대학교 대학원
- 지도교수 서보경
- 발행년도 2019
- 학위수여년월 2019. 2
- 유형 Text
- 학위구분 석사
- 학과 대학원 의학과(일반대학원)
- 세부전공 영상의학전공
- 원문페이지 51 p
- 실제URI http://www.dcollection.net/handler/korea/000000082923
- UCI I804:11009-000000082923
- DOI 10.23186/korea.000000082923.11009.0000826
- 본문언어 한국어
- 제출원본 000045980223
초록/요약
Objective: To investigate the value of ultrasound microflow assessment in distinguishing malignant from benign solid breast masses and the association between ultrasound parameters and histologic microvessel density (MVD). Materials and Methods: Ninety-eight breast masses (57 benign and 41 malignant) were examined using Superb Microvascular Imaging (SMI) and contrast-enhanced ultrasound (CEUS) before biopsy. The quantitative and qualitative vascular parameters on SMI (vascular index, morphology, distribution, and penetration) and CEUS (time–intensity curve analysis and enhancement characteristics) were evaluated. Vascular parameters were compared between benign and malignant masses and the diagnostic performance was compared between SMI and CEUS. Subgroup analysis was done according to the lesion size. The effect of vascular parameters on downgrading BI-RADS category 4A masses was evaluated. The association between histologic MVD and ultrasound parameters was analyzed. Results Malignant masses were associated with high vascular index (15.1±7.3 vs. 5.9±5.6), complex vessel morphology (82.9% vs. 42.1%), central vascularity (95.1% vs. 59.6%), penetrating vessels (80.5% vs. 31.6%) on SMI (p<0.001), and high peak intensity (37.1±25.7 vs. 17.0±15.8), slope (10.6±11.2 vs. 3.9±4.2), area (1035.7±726.9 vs. 458.2±410.2), hyperenhancement (95.1% vs. 70.2%), centripetal enhancement (70.7% vs. 45.6%), penetrating vessels (65.9% vs. 22.8%), perfusion defects (31.7% vs. 3.5%) on CEUS (p≤0.023). The areas under the receiver-operating characteristic curve (AUC) of SMI and CEUS were 0.853 and 0.841 (p=0.803). In 19 masses measuring<10 mm, only central vascularity on SMI was associated with malignancy (100% vs 38.5%, p=0.018). In adding all benign SMI parameters on BI-RADS assessment, 10 masses can avoid unnecessary biopsy with improved AUC (0.917 vs 0.914, p=0.001). Ultrasound vascular parameters associated with malignancy showed higher MVD (p≤0.016). MVD was higher in malignant masses than benign masses and malignant masses with negative estrogen receptor or positive Ki67 had higher MVD (p<0.05). Conclusion Ultrasound microflow assessment using SMI and CEUS is valuable in distinguishing malignant from benign solid breast masses and ultrasound vascular parameters are associated with histologic MVD.
more목차
I. Introduction 1
II. Materials and Methods 3
III. Results 7
IV. Discussion 11
V. References 14
VI. Figures and Table 18
