Kook Shin-Ho, Kwag Hyon-Joo
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, 108 Pyeong-Dong, Jongro-Gu, Seoul 110-108, South Korea.
J Clin Ultrasound. 2003 Jun;31(5):227-38. doi: 10.1002/jcu.10172.
The purpose of this study was to prospectively evaluate the usefulness of contrast-enhanced power Doppler sonography (PDUS) using a microbubble echo-enhancing agent in differentiating between malignant and benign small breast lesions.
Between July 1, 2000, and September 30, 2001, we performed gray-scale sonographic examination of patients in whom diagnostic sonography or screening mammography had revealed solid breast lesions measuring less than 2 cm in the largest dimension. The patients were then examined on PDUS before and after injection of a microbubble contrast agent. The sonographic findings for all 3 techniques, as well as the morphologic features of the Doppler signals for each patient before and after injection of the contrast agent on PDUS, were independently assessed. Each lesion was classified as "benign" or "malignant" on the basis of specific criteria for sonographic interpretation. A hemodynamic study was performed in which time-transit profiles of the Doppler signals on contrast-enhanced PDUS were generated using a computer-assisted program, and the results for each patient were compared with the findings of a histopathologic examination of surgical specimens.
Thirty-six patients (35 women and 1 man) with a mean age of 43.5 years (range, 18-69 years) were evaluated. The tumors ranged from 4 to 19 mm in the largest dimension. Histopathologic examination revealed that 19 tumors were benign and 17 were malignant. For morphologic diagnosis of the malignant lesions, the sensitivity of gray-scale sonography was 100%, compared with 29% for PDUS without contrast enhancement. The specificity of gray-scale sonography was 47%, compared with 74% for PDUS without contrast enhancement. Contrast-enhanced PDUS had a sensitivity of 71% and a specificity of 58%. The diagnostic accuracy was 72% for gray-scale sonography, 53% for PDUS without contrast enhancement, and 64% for contrast-enhanced PDUS. The time-transit profiles of the hemodynamic study did not reveal a statistically significant difference in the accuracy rates of contrast-enhanced PDUS between benign and malignant breast lesions.
Compared with PDUS without contrast enhancement, contrast-enhanced PDUS provides better visualization of the morphology of vascular Doppler signals that is characteristic of malignancy and therefore has a higher sensitivity and diagnostic accuracy, albeit a lower specificity. In differentiating between benign and malignant small breast lesions, contrast-enhanced PDUS can be helpful when used with gray-scale sonography and PDUS without contrast enhancement.
本研究的目的是前瞻性评估使用微泡回声增强剂的超声造影功率多普勒超声检查（PDUS）在鉴别乳腺小病变良恶性方面的实用性。
在2000年7月1日至2001年9月30日期间，我们对经诊断性超声或乳腺筛查钼靶检查发现最大径小于2 cm的实性乳腺病变患者进行了灰阶超声检查。然后在注射微泡造影剂前后对患者进行PDUS检查。对所有三种技术的超声检查结果以及PDUS检查中注射造影剂前后每位患者多普勒信号的形态特征进行独立评估。根据超声检查的特定标准，将每个病变分类为“良性”或“恶性”。进行了一项血流动力学研究，使用计算机辅助程序生成超声造影PDUS上多普勒信号的时间-通过曲线，并将每位患者的结果与手术标本的组织病理学检查结果进行比较。
对36例患者（35名女性和1名男性）进行了评估，平均年龄43.5岁（范围18 - 69岁）。肿瘤最大径为4至19 mm。组织病理学检查显示，19个肿瘤为良性，17个为恶性。对于恶性病变的形态学诊断，灰阶超声的敏感性为100%，无造影增强的PDUS为29%。灰阶超声的特异性为47%，无造影增强的PDUS为74%。超声造影PDUS的敏感性为71%，特异性为58%。灰阶超声的诊断准确率为72%，无造影增强的PDUS为53%，超声造影PDUS为64%。血流动力学研究的时间-通过曲线未显示乳腺良恶性病变之间超声造影PDUS准确率的统计学显著差异。
与无造影增强的PDUS相比，超声造影PDUS能更好地显示具有恶性特征的血管多普勒信号形态，因此具有更高的敏感性和诊断准确率，尽管特异性较低。在鉴别乳腺小病变的良恶性时，超声造影PDUS与灰阶超声和无造影增强的PDUS联合使用可能会有帮助。
