Bäz E, Madjar H, Reuss C, Vetter M, Hackelöer B, Holz K
Department of Fetomaternal Medicine, Allgemeines Krankenhaus Barmbek, Hamburg, Germany.
Ultrasound Obstet Gynecol. 2000 May;15(5):377-82. doi: 10.1046/j.1469-0705.2000.00116.x.
To evaluate the benefit of echo-contrast-enhanced Doppler sonography in the differentiation of benign vs. malignant breast lesions after surgical removal of a malignant breast mass.
Thirty-eight patients referred for biopsy of a palpable, suspicious scar lesion 1-15 years (mean 3.3 years) after surgery for breast cancer were examined. During baseline ultrasound examination a subjective scoring system of the vascularity, the number, the regularity of vessels' course and their Doppler parameters were assessed. After injection of an ultrasound contrast agent (Levovist) the same scoring system was applied to the parameters together with enhancement kinetics, enhancement intensity and enhancement pattern. Any increase in the scoring level of two or more characteristics (vascularity, number of vessels, intensity of enhancement in the tumor or regularity score of vessels in the lesion) was defined as suspicious for malignancy. A marked increase of enhancement in the immediate tumor periphery was also regarded as suspicious for malignancy. The sonographic results were assessed prospectively and correlated with the histology of the lesion.
Of the 38 patients with a clinically-suspicious scar lesion, there were 28 true scars and 10 malignant scar lesions. All scar lesions showed no or slight vascularity on baseline sonography. After Echocontrast-enhancement a significant increase in tumor vascularity and the number of tumor vessels could be demonstrated in all 10 malignant lesions but in only one of the 28 benign scars.
Scars pose inherent technical problems for optimal mammography. Sonographic evaluation of the vascularity of the lesion with contrast enhancing agents showed improved diagnostic accuracy in the hands of an experienced examiner.
评估超声造影增强多普勒超声检查在乳腺癌肿块手术切除后鉴别良性与恶性乳腺病变中的作用。
对38例患者进行检查，这些患者在乳腺癌手术后1至15年（平均3.3年）因可触及的可疑瘢痕病变而被转诊进行活检。在基线超声检查期间，评估血管分布、血管数量、血管走行的规律性及其多普勒参数的主观评分系统。注射超声造影剂（Levovist）后，将相同的评分系统应用于这些参数，同时评估增强动力学、增强强度和增强模式。两个或更多特征（血管分布、血管数量、肿瘤内增强强度或病变内血管规律性评分）的评分水平增加被定义为恶性可疑。肿瘤周边立即出现的明显增强也被视为恶性可疑。前瞻性评估超声检查结果并与病变的组织学结果相关联。
在38例临床可疑瘢痕病变患者中，有28例为真性瘢痕，10例为恶性瘢痕病变。所有瘢痕病变在基线超声检查时均无或仅有轻微血管分布。超声造影增强后，所有10例恶性病变均显示肿瘤血管分布和肿瘤血管数量显著增加，但28例良性瘢痕中只有1例出现这种情况。
瘢痕给最佳乳腺摄影带来了固有的技术问题。在经验丰富的检查者手中，使用造影剂对病变血管分布进行超声评估显示诊断准确性有所提高。
