Nuclear Medicine, Charing Cross Hospital, London, UK.
Ultraschall Med. 2010 Oct;31(5):466-74. doi: 10.1055/s-0028-1109478. Epub 2010 Jan 21.
The aim of this study was to evaluate the use of vascular morphology, around and within the B-mode region of abnormality, for improving the diagnostic accuracy of two of the most common solid breast pathologies.
The B-mode and Doppler images of 117 breast cancers and 366 fibroadenomas and lesions with a fibroadenoma-like appearance were reviewed retrospectively and the morphology of the vascular pattern was evaluated. The ratio of external to internal color Doppler, the external vascular pattern and the connecting vessels to internal vessels were assessed and differentiated into benign and malignant vascular patterns. These patterns were correlated with the histological diagnosis.
Vascularity was demonstrated in 95 % of cancers and in 46 % of benign lesions with a trend to increasing vascularity in cancers. This provided poor specificity for excluding cancer in fibroadenomas. Variations in vascular pattern were recorded. The observed benign vascular patterns were avascularity, vascularity in the periphery and peripheral marginal vessels connecting with internal vascularity. The observed malignant vascular patterns were radially aligned external vessels with internal vessels being more numerous than external vessels which connected to radial vessels. (Fisher exact test p < 0.0001). Analysis of the vascular morphology improved the sensitivity for identifying cancers from 97 % (B-mode) to 99 % (B-mode and color Doppler) with a minimal reduction in specificity (93.7 to 92.6 %) or accuracy (94.6 to 94.2 %).
The presence of vascularity within a lesion, by itself, is no longer a good predictor of malignancy because of the increase in Doppler sensitivity associated with improvements in ultrasound technology. The color Doppler ultrasound vascular pattern morphology improves the accuracy and sensitivity of B-mode image diagnosis, breast cancers and fibroadenomas with a minimal loss of specificity. Any breast lesion with radial rather than marginal connecting vessels should be regarded with suspicion.
本研究旨在评估血管形态（异常的 B 超区域内外）在提高两种最常见的实性乳腺病变的诊断准确性方面的应用。
回顾性分析了 117 例乳腺癌、366 例纤维腺瘤和纤维腺瘤样病变的 B 超和多普勒图像，并对血管形态进行了评估。评估了外部和内部彩色多普勒的比值、外部血管形态以及与内部血管的连接血管，并将其分为良性和恶性血管形态。将这些形态与组织学诊断进行了相关性分析。
95%的癌症和 46%的良性病变显示有血管，癌症的血管丰富度呈上升趋势。这使得纤维腺瘤排除癌症的特异性较差。记录了血管形态的变化。观察到的良性血管形态为无血管、周边血管和与内部血管相连的周边边缘血管。观察到的恶性血管形态为呈放射状排列的外部血管，内部血管数量多于外部血管，且与放射状血管相连。（Fisher 确切概率检验，p < 0.0001）。血管形态分析将识别癌症的敏感性从 B 超的 97%提高到 99%（B 超和彩色多普勒），特异性（从 93.7%降至 92.6%）或准确性（从 94.6%降至 94.2%）略有下降。
由于与超声技术改进相关的多普勒敏感性提高，病变内存在血管本身不再是恶性肿瘤的良好预测指标。彩色多普勒超声血管形态学提高了 B 超图像诊断的准确性和敏感性，特异性略有降低。任何具有放射状而不是边缘连接血管的乳腺病变都应引起怀疑。
