Contrast enhanced ultrasound (CEUS) of impalpable breast lesions.
Authors:
K. Dvořák; V. Válek; J. Patera; M. Třináctá; E. Jandáková; Z. Pačovský; M. Kuzárová; R. Jakubcová; J. Foukal
Authors‘ workplace:
Fakultní nemocnice Brno, Česká republika
Published in:
Prakt Gyn 2009; 13(4): 202-212
Overview
Aim:
The main aim of this pilot project was to determine benefits and assess sensitivity/ specificity of contrast enhanced ultrasound (CEUS) using 2nd generation contrast agent SONOVUE® for detection of impalpable breast lesions with mammography and native ultrasound with Doppler examination as references and with histological verification of lesions [6 – 10]. The secondary aim was to assess the value of CEUS in monitoring the outcomes of neoadjuvant chemotherapy (a group of 15 patients with lobular carcinoma).
Methods:
The total amount of 2,4 ml of contrast agent SONOVUE® followed by lavage with 5 ml of saline was administered to 126 patients (63 malignant and 63 benign lesions); histological examination was carried out in both groups of women. Sonography was performed with iU22 Philips and L 9 – 3 MHz linear probe, in harmonic mode using microvascular imaging and QLAB® software. The low mechanical index of 0,07 was used for early microbubble destruction and to obtain optimal image quality. Vascular signs, microvascular architecture, number of vessels [1 – 5], degree of enhancement, time intensity curves together with area under the curve (AUC), time to peak (TTP), in‑flow gradient (IFG), peak enhancement (PE) and out ‑ flow gradient (OFG – contrast wash out time) were obtained using QLAB software, 5 mm ROI (region of interest) was positioned in the centre of a lesion and 1 cm away from the lesion in an intact parenchyma. The CEUS results were processed statistically together with all diagnostic imaging techniques.
Results:
The obtained results provided statistically significant differentiation of benign and malignant lesions. Sensitivity of CEUS in the malignant lesions group was 98% and specificity 92 %, sensitivity in the benign lesions group was 89 % and specificity 82 %
Key words:
contrast enhanced ultrasound – CEUS – Doppler examination – SonoVue® – harmonic image – QLAB – mammography – histology
Sources
1. Passe TJ, Bluemke DA, Siegelman SS. Tumor angiogenesis: tutorial on implications for imaging. Radiology 1997; 203(3): 593 – 600.
2. Cosgrove D. Angiogenesis imaging ultrasound. Br J Radiol 2003; 76 : 43 – 49.
3. Casparini G, Hariss AL. Clinical importance of the determination of tumor angiogenesis in breast carcinoma: much more than a new prognostic tool. J Clin Oncol 1995; 13(3): 765 – 782.
4. Dilantha B, Ellegala, Howard Leong‑Poi, Joan E Carpenter et al. Imaging Tumor Angiogenesis with Contrast Ultrasound and Microbubbles Targeted to avb3. circ. ahajournals.org/ cgi/ 2003;108/ 3/ 336.
5. Gosgrove DO, Kedar RP, Bamber JC et al. Breast diseases: Color Doppler US in differential diagnosis. Radiology 1993; 189(1): 99 – 104.
6. Madjar H, Prömpeler HJ, SauerbreiW et al. Color Doppler flow criteria of breast lesions. Ultrasound Med Biol 1994; 20(9): 849 – 858.
7. van Esser S, Veldhuis WB, van Hillegersberg R et al. Accuracy of contrast ‑ enhanced breast ultrasound for pre‑operative tumor. Cancer Imaging 2007; 7 : 63 – 68.
8. Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002; 225(1): 165 – 175.
9. Alamo I, Fischer U. Contrast ‑ enhanced color Doppler ultrasound characteristics in hypervascular breast tumors: comparison with MRI. Eur Radiol 2001; 11(6): 970 – 977.
10. Reinikainen H, Rissanen T, Paivansalo M. B ‑ mode, power Doppler and contrastenhanced power Doppler ultrasonography in the diagnosis of breast tumors. Acta Radiol 2001; 42(1): 106 – 113.
11. Milz P, Lienemann A, Kessler M et al. Evaluation of breast lesions by power Doppler sonography. Eur Radiol 2001; 11(4): 547 – 554.
12. Stuhrmann M, Aronius R, Schietzel M. Tumor vascularity of breast lesions: potentials and limits of contrast enhanced Doppler sonography. AJR Am J Roentgenol 2000; 175(6): 1585 – 1589.
13. Moon WK, Im JG, Noh DY et al. Nonpalpable breast lesions: evaluation with power Doppler US and a microbubble contrast agent – initial experience. Radiology 2000; 217(1): 240 – 246.
14. Kedar RP, Cosgrove D, McCready VR et al. Microbubble contrast agent for color Doppler US:effect on breast masses – work in progress. Radiology 1996; 198(3): 679 – 686.
15. Aichinger U, Schulz ‑ Wendtland R, Krämer S. Scar or recurrence – comparison of MRI and color ‑ coded ultrasound with echo signal amplifiers. RöFo Fortschr Röntgenstr 2002; 174(11): 1395 – 1401.
16. Pudszuhn A, Marx Ch, Malich A et al. Prospective analysis of quantification of contrast media enhanced power Doppler sonography of equivocal breast lesions. RöFo Fortschr Röntgenstr 2003; 175(4): 495 – 501.
17. Schroeder RJ, Bostanjoglo M, Rademaker J et al. Role of power Doppler techniques and ultrasound contrast enhancement in the differential diagnosis of focal breast lesions. Eur Radiol 2003; 13(1): 68 – 79.
18. Wible JH, Wojdyla JK, Hughes MS et al. Effects of transducer frequency and output power on the ultrasonographic contrast produced by Optison using fundamental and harmonic imaging techniques. J Ultrasound Med 1999; 18(11): 753 – 762.
19. Huber S, Delorme S, Zuna I. Dynamic assessment of contrast medium enhancement in Doppler ultrasound imaging, Current status. Radiology 1998; 38(5): 390 – 393.
20. Baz E, Madjar H, Reuss C et al. The role of enhanced Doppler ultrasound in differentiation of benign vs. malignant scar lesion after breast surgery for malignancy. Ultrasound Obstet Gynecol 2000; 15(5): 377 – 382.
21. Moon WK, Im JG, Noh DY. Nonpalpable Breast Lesions: Evaluation with Power Doppler US and a Microbubble Contras Agent – Initial Experience. Radiology 2000; 217(1): 240 – 246.
22. Milz P, Lienemann A, Kessler M. Evaluation of Brest lesions by power Doppler sonography. Eur Radiol 2001; 11(4): 547 – 554.
23. Kook SH, Park HW, Lee YR et al. Evaluation of solid Brest lesions with power Doppler sonography. J Clin Ultrasound 1999, 27(5): 231 – 237.
24. Birdwell RL, Ikeda DM, Jeffrey SS. Preliminary experience with power Doppler imaging of solid breast masses. Am J Roentgenol 1997; 169(3): 703 – 707.
25. Gökhan AKBAŞ, Ayşe MURAT AYDIN, Hakan ARTAŞ, Erkin OĞUR: Evaluation of Solid Breast Masses With Power Doppler Sonography, 2008, Cilt 13, Sayı 2, Sayfa(lar) 102 – 106.
26. Sarraco A, Aspelin P, Leifland K et al. Real time contrast enhanced ultrasound harmonic imaging on characterizing breast lesions. Röntgenveckan 2008, Abstract 032, Uppsala.
27. Barnard S, Leen E, Cooke T. A contrast ‑ enhanced ultrasound of benign and malignant breast tissue. S Afr Med J 2008; 98(5): 386 – 391.
28. Mankoff DA, Dunnwald LK, Gralow JR. Blood Flow and Metabolism in Locally Advanced Breast Cancer: Relationship to Response to Therapy. J Nucl Med 2002; 43(4): 500 – 509.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Practical Gynecology
2009 Issue 4
Most read in this issue
- Venous duct dopplerometry.
- Prognosis of women with breast cancer and sentinel lymph node micrometastases.
- Contrast enhanced ultrasound (CEUS) of impalpable breast lesions.
- Microbiological properties of endogenous vaginal flora strains in asymptomatic women of childbearing potential.