Blohmer Jens-Uwe, Reinhardt Michael, Schmalisch Gerd, Lichtenegger Werner, Hausschild Maik, Kümmel Sherko, Fischer Thomas, Ohlinger Ralf, Thomas Anke
Department of Senology, St. Gertrauden-Krankenhaus, Paretzer Str. 11/12, 10713 Berlin, Germany.
Anticancer Res. 2006 Mar-Apr;26(2C):1691-8.
The present investigation aimed at assessing the possibility of distinguishing between malignant and benign breast lesions by measuring the signal intensity in vessels of the suspect lesions over time after administration of the ultrasound contrast agent Levovist.
Levovist was administered intravenously to 21 patients with breast cancer and 12 patients with a benign breast lesion. In the subsequent ultrasound investigation (Color Power Angiography) the resulting increase in brightness over time in the vessels of the lesions was measured using the videodensitometry method. From the calculated time-brightness curves, the time to maximum brightness (T(max)), time to 90% of maximum brightness (T(90%)), maximum brightness and other time and brightness parameters were determined. The data were analyzed by means of the Mann-Whitney-Wilcoxon test. Additionally, the sensitivity and specificity were calculated for a sequence of cut-off levels for T(90%), T(max) maximum brightness and wash-in wash-out parameters.
The differences between the benign and the malignant lesions for the parameters T(max) and T(90%) were statistically significant. The malignant foci showed a significantly more rapid in-flow of the contrast agent (p = 0.006) than the benign lesions. The wash-in wash-out time for Levovist was significantly shorter for the malignant lesions than for the benign lesions (p = 0.02). The time difference in attaining maximum brightness was not significant (p = 0.14). The specificity and sensitivity made a more precise differentiation between benign and malignant tumors possible.
The use of a contrast agent in Doppler ultrasound enhances the diagnostic reliability in distinguishing between malignant and benign lesions, justifying the use of a contrast agent with a high specificity (92%) such as Levovist. However, invasive pre-operative methods such as punch biopsy are not, thereby, rendered unneccessary. It is possible that the combination of Levovist and videodensitometry will make it possible to increase the specificity of breast cancer diagnosis.
本研究旨在通过在静脉注射超声造影剂声诺维后，测量可疑乳腺病变血管内随时间变化的信号强度，评估鉴别乳腺良恶性病变的可能性。
对21例乳腺癌患者和12例乳腺良性病变患者静脉注射声诺维。在随后的超声检查（彩色能量血管造影）中，采用视频密度测定法测量病变血管内亮度随时间的增加情况。从计算出的时间-亮度曲线中，确定达到最大亮度的时间（T(max)）、达到最大亮度90%的时间（T(90%)）、最大亮度以及其他时间和亮度参数。采用曼-惠特尼-威尔科克森检验对数据进行分析。此外，还针对T(90%)、T(max)、最大亮度和进出时间参数的一系列临界值计算了敏感度和特异度。
T(max)和T(90%)参数在良性和恶性病变之间的差异具有统计学意义。恶性病灶显示造影剂流入明显比良性病变更快（p = 0.006）。声诺维的进出时间在恶性病变中明显短于良性病变（p = 0.02）。达到最大亮度的时间差异不显著（p = 0.14）。特异度和敏感度使得更精确地区分良性和恶性肿瘤成为可能。
在多普勒超声中使用造影剂可提高鉴别良恶性病变的诊断可靠性，这证明使用如声诺维这种具有高特异度（92%）的造影剂是合理的。然而，诸如穿刺活检等侵入性术前方法并非因此就不再必要。声诺维和视频密度测定法相结合有可能提高乳腺癌诊断的特异度。
