Department of Radio-diagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India.
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, India.
Acta Radiol. 2023 Jun;64(6):2087-2095. doi: 10.1177/02841851231160076. Epub 2023 Mar 8.
Tumor neo-angiogenesis plays an important role in the development and growth of breast cancers, but its detection by imaging is challenging. A novel microvascular imaging (MVI) technique, Angio-PLUS, promises to overcome the limitations of color Doppler (CD) in detecting low-velocity flow and small diameter vessels.
To determine the utility of the Angio-PLUS technique for detecting blood flow in breast masses and compare it with CD for differentiating benign from malignant masses.
A total of 79 consecutive women with breast masses were prospectively evaluated using CD and Angio-PLUS techniques, and biopsied as per BI-RADS recommendations. Vascular imaging scores were assigned using three factors (number, morphology, and distribution) and vascular patterns were divided into five groups: internal-dot-spot, external-dot-spot, marginal, radial, and mesh patterns. The independent samples -test, Mann-Whitney U test, Wilcoxon signed rank test, or Fisher's exact test were used to compare the two groups as appropriate. Area under the receiver operating characteristic (ROC) curve (AUC) methods were used to assess diagnostic accuracy.
Vascular scores were significantly higher on Angio-PLUS than CD (median=11, [IQR=9-13] vs. 5 [IQR=3-9], < 0.001). Malignant masses had higher vascular scores than benign masses on Angio-PLUS ( < 0.001). AUC was 80% (95% CI=70.3-89.7; < 0.001) for Angio-PLUS and 51.9% for CD. Using Angio-PLUS at a cutoff value of ≥9.5, sensitivity was 80% and specificity was 66.7%. Vascular pattern descriptors on AP showed good correlation with histopathological results (PPV mesh 95.5%, radial 96.9%, and NPV of marginal orientation 90.5%).
Angio-PLUS was more sensitive in detecting vascularity and superior in differentiating benign from malignant masses compared to CD. Vascular pattern descriptors on Angio-PLUS were useful.
肿瘤新生血管在乳腺癌的发展和生长中起着重要作用，但通过影像学进行检测具有挑战性。一种新的微血管成像（MVI）技术 Angio-PLUS 有望克服彩色多普勒（CD）在检测低流速和小直径血管方面的局限性。
确定 Angio-PLUS 技术检测乳腺肿块血流的效用，并将其与 CD 技术区分良恶性肿块的能力进行比较。
对 79 例连续的乳腺肿块患者进行前瞻性评估，分别采用 CD 和 Angio-PLUS 技术，并根据 BI-RADS 建议进行活检。使用三个因素（数量、形态和分布）对血管成像评分进行赋值，并将血管模式分为五类：内部点状-斑点、外部点状-斑点、边缘、放射状和网状。使用独立样本 t 检验、Mann-Whitney U 检验、Wilcoxon 符号秩检验或 Fisher 确切检验对两组进行适当比较。使用受试者工作特征（ROC）曲线下面积（AUC）方法评估诊断准确性。
Angio-PLUS 的血管评分明显高于 CD（中位数=11，[IQR=9-13] 比 5 [IQR=3-9]，<0.001）。恶性肿块的 Angio-PLUS 血管评分高于良性肿块（<0.001）。Angio-PLUS 的 AUC 为 80%（95%CI=70.3-89.7；<0.001），CD 的 AUC 为 51.9%。使用 Angio-PLUS 的截断值≥9.5 时，敏感性为 80%，特异性为 66.7%。AP 上的血管模式描述符与组织病理学结果具有良好的相关性（PPV 网状 95.5%、放射状 96.9%和边缘方向的 NPV 90.5%）。
与 CD 相比，Angio-PLUS 更能敏感地检测血管生成，并且在区分良恶性肿块方面更具优势。Angio-PLUS 上的血管模式描述符具有一定的应用价值。
