Department of Ultrasonography, Nanfang Hospital, Southern Medical University, 1838 N Guangzhou Blvd, 510515 Guangzhou, China.
J Ultrasound Med. 2013 Jul;32(7):1145-55. doi: 10.7863/ultra.32.7.1145.
The purpose of this study was to investigate the perfusion heterogeneity of malignant and benign breast tumors and assay their vascular architecture changes and molecular expression, thereby evaluating the relevance between imaging and histologic characteristics of angiogenesis.
Real-time grayscale contrast-enhanced sonography was performed in 310 women with 317 breast tumors. The enhancement patterns and perfusion parameters for malignant and benign tumors were analyzed by contrast-enhanced sonography with microvascular imaging and quantitative time-intensity curve analysis. Structural characteristics were observed by light and electron microscopy. The microvessel density, vascular endothelial growth factor (VEGF) expression, and human kinase insert domain-containing receptor (KDR) expression for all tumors were assessed by immunohistochemical staining of CD31, KDR, and VEGF.
Surgical pathologic analysis showed 163 malignant and 154 benign tumors. Significant morphologic differences, including perfusion defects, vessel distortion, vessel dilatation, and heterogeneous enhancement, were observed between the malignant and benign groups (P < .05). The mean perfusion parameters (peak intensity, ascending slope, area under the curve, and wash-out time) were greater in the malignant tumors (P < .05). There were significant differences in the peak intensity, ascending slope, area under the curve, and wash-out time between peripheral and central regions of the malignant tumors (P < .05) but none in the benign tumors. Vessels had various morphologic and distributional characteristics in the peripheral and central regions of the malignant tumors. The microvessel density and VEGF and KDR expression were significantly higher in the malignant group (P < .05), especially in the peripheral regions.
Perfusion heterogeneity was closely associated with the tumor microvascular architecture and molecular expression. Perfusion features, especially regional morphologic and hemodynamic features, can provide valuable information for differentiating malignant from benign breast tumors.
本研究旨在探讨良恶性乳腺肿瘤的灌注异质性，并检测其血管结构改变和分子表达情况，从而评估成像与血管生成的组织学特征之间的相关性。
对 310 例 317 个乳腺肿瘤的女性患者进行实时灰阶超声造影检查。采用微血管成像和定量时间-强度曲线分析对良恶性肿瘤的增强模式和灌注参数进行分析。通过光镜和电镜观察结构特征。应用 CD31、KDR 和 VEGF 免疫组化染色评估所有肿瘤的微血管密度、血管内皮生长因子（VEGF）表达和人激酶插入结构域受体（KDR）表达。
手术病理分析显示 163 个恶性肿瘤和 154 个良性肿瘤。恶性组和良性组之间存在明显的形态差异，包括灌注缺损、血管扭曲、血管扩张和不均匀增强（P <.05）。恶性肿瘤的平均灌注参数（峰值强度、上升斜率、曲线下面积和洗脱时间）较大（P <.05）。恶性肿瘤的中央和周边区域的峰值强度、上升斜率、曲线下面积和洗脱时间均存在显著差异（P <.05），而良性肿瘤则无差异。恶性肿瘤的周边和中央区域的血管具有不同的形态和分布特征。恶性组的微血管密度、VEGF 和 KDR 表达明显较高（P <.05），特别是在周边区域。
灌注异质性与肿瘤微血管结构和分子表达密切相关。灌注特征，特别是区域性形态和血流动力学特征，可为良恶性乳腺肿瘤的鉴别提供有价值的信息。
