Chen Man, Wang Wen-ping, Jia Wan-ru, Tang Lei, Wang Yi, Zhan Wei-wei, Fei Xiao-chun
Department of Diagnostic Ultrasound, Zhong Shan Hospital, Fudan University School of Medicine, 180 Fen Lin Rd, 200032 Shanghai, China.
J Ultrasound Med. 2014 May;33(5):835-46. doi: 10.7863/ultra.33.5.835.
The purpose of this study was to differentiate perfusion and vascular characteristics between benign and malignant breast lesions by 3-dimensional contrast-enhanced sonography and evaluate their correlation with microvessel density and vascular endothelial growth factor (VEGF) expression for further clinical exploration.
Three-dimensional contrast-enhanced sonography was performed in 183 patients with breast lesions, and sonographic characteristics were carefully observed for further analysis. The mean microvessel density and VEGF expression were measured by immunohistochemical analysis.
Pathologic results showed 35 benign and 148 malignant cases. Malignancy and benignity differed significantly in peripheral vessel characteristics (number, distribution, course, degree of dilatation, and penetrating vessels), rim perfusion and coarseness degree, intratumoral perfusion type, and intratumoral vessel dilatation (P< .05) but not the presence of peripheral and intratumoral vessels and intratumoral perfusion (P > .05). The specificity of penetrating vessels was 88.6% for diagnosing malignancy. The sensitivity, specificity, and accuracy of rim perfusion coarseness were 90.2%, 70.4%, and 85.3% respectively. The sensitivity of the intratumoral perfusion type was 77.8%, whereas the specificity of intratumoral vessel dilatation was 88.9%. Microvessel density and VEGF expression were significantly correlated with perfusion and vascular characteristics (P < .05), except the presence of peripheral vessels, rim perfusion, and intratumoral perfusion (P> .05). The presence of intratumoral vessels was related to VEGF (P< .05) but not microvessel density (P > .05).
Three-dimensional contrast-enhanced sonographic characteristics were statistically different between benign and malignant breast lesions. Some of them also correlated significantly with microvessel density and VEGF expression and therefore have potential for objective evaluation of tumor angiogenesis.
本研究旨在通过三维对比增强超声鉴别乳腺良恶性病变的灌注及血管特征，并评估其与微血管密度及血管内皮生长因子（VEGF）表达的相关性，以供进一步临床探索。
对183例乳腺病变患者进行三维对比增强超声检查，仔细观察超声特征以作进一步分析。采用免疫组织化学分析法测定平均微血管密度及VEGF表达。
病理结果显示35例良性病变和148例恶性病变。良恶性病变在外周血管特征（数量、分布、走行、扩张程度及穿入血管）、边缘灌注及粗糙程度、瘤内灌注类型和瘤内血管扩张方面差异有统计学意义（P<0.05），但在外周和瘤内血管的存在及瘤内灌注方面差异无统计学意义（P>0.05）。穿入血管诊断恶性病变的特异性为88.6%。边缘灌注粗糙程度的敏感性、特异性和准确性分别为90.2%、70.4%和85.3%。瘤内灌注类型的敏感性为77.8%，而瘤内血管扩张的特异性为88.9%。微血管密度和VEGF表达与灌注及血管特征显著相关（P<0.05），但外周血管的存在、边缘灌注和瘤内灌注除外（P>0.05）。瘤内血管的存在与VEGF相关（P<0.05），但与微血管密度无关（P>0.05）。
乳腺良恶性病变的三维对比增强超声特征存在统计学差异。其中一些特征还与微血管密度和VEGF表达显著相关，因此具有客观评估肿瘤血管生成的潜力。
