New potential and applications of contrast-enhanced ultrasound of the breast: Own investigations and review of the literature
Section snippets
Principles of tumor vascularization and hypothetical clinical applications of contrast-enhanced ultrasound of the breast
US contrast agents with microbubbles are used to increase vascular signals at Doppler US and have been shown to improve color Doppler US assessment of tumoral vessels in breast lesions, despite typical motion and blooming artifacts and early signal saturation. Contrast-enhanced ultrasonography (CEUS) of the breast is less commonly performed than abdominal CEUS. Nevertheless, several authors had focussed on the possible application of sonographic contrast media to breast imaging [1], [2]. Main
Main features of vascularization and Doppler imaging in breast lesions
Angiogenesis plays a major role in the development of breast cancer. Both tumor growth and metastatic seeding are strongly related with the angiogenetic process [3]. It is also recognized that borderline lesions, considered as potentially malignant like atypical hyperplasia or the lobular carcinoma in situ have an overall vascularization more prominent than that of truly benign lesions. Among hypervascularized lesions, there is also a relationship between the density of the vessels and the
What are the clinical applications?
It is possible to evaluate the vascularization of breast masses with MRI using intravenous injection of Gadolinium chelate, and with CT using intravenous injection of iodine. As a statement, EUS could claim the same role than contrast-enhanced MRI which are the following:
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Characterization of an inconclusive mass on mammography and/or breast sonography and improvement for the differentiation between benign and malignant breast masses.
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Staging of ductal infiltrative cancers, especially in patients
Detection modes
Non-harmonic [10] and harmonic [11] US imaging techniques with air-filled contrast agents may overcome the limitations of color Doppler US and allow effective characterization of ambiguous breast lesions. Pulse-inversion harmonic imaging (PIHI) is a contrast-enhanced harmonic technique that works by sending two out-of-phase pulses and summing returning echoes. During low acoustic power imaging, microbubbles present a much higher non-linear behaviour than native tissues, expanding from a
Characterization of breast masses
Due to angiogenesis, vascularization of malignant lesions is more prominent than that of benign masses [17], [18]. Vessels morphology is also different: malignant vessels are tortuous and somewhat irregular; there is no muscular layer in these vessels, and the arterial wall is not elastic; vessels are more prominent in the peripheral part of the tumor than in the middle [19]. Resistive and pulsatility indices measured with Pulsed Doppler are higher than that of benign tumors. Resistive index
Discussion
From the literature, specificity is greatly improved using contrast media [28]. Nevertheless, of these higher specificity could be associated with a weaker sensitivity [29]. In this study, the authors have tried to determine the added value of contrast media in addition to regular sonography and Doppler imaging. They tried to classify the lesions according to the BIRADS classification for the B mode imaging, power Doppler imaging and contrast US with Levovist®. Among 69 cases (28 malignant, 41
Evaluation of tumor response after neoadjuvant chemotherapy
Early assessment of tumor response after chemotherapy is critical. It is one of the major prognostic factors in breast cancer [33]. Large tumors (>3 cm) or high grade tumors are usually treated with chemotherapy as a first-line treatment. The aim is to decrease the tumor size, to facilitate a conservative treatment when possible and to limit the possibility of metastatic spreading [34]. Mammography and plain sonography are not sufficient to evaluate the tumor size in response to treatment
Conclusion
The role of CEUS remains to be defined in many aspects. Its position in the strategy for the detection staging and follow-up of breast lesions is still unclear. The characteristics of tumor enhancement remain to be clarified with series using state-of-the-art equipment and second-generation contrast media, because previous series were too heterogeneous. Software allowing a more robust analysis of the enhancement curve characteristics should also facilitate the reproducibility. Acquisition
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Four-quadrant fast compressive tracking of breast ultrasound videos for computer-aided response evaluation of neoadjuvant chemotherapy in mice
2022, Computer Methods and Programs in BiomedicineMeta-Analysis: Contrast-Enhanced Ultrasound Versus Conventional Ultrasound for Differentiation of Benign and Malignant Breast Lesions
2018, Ultrasound in Medicine and BiologyCitation Excerpt :It has been demonstrated that angiogenesis plays an important role in the development of breast cancer in terms of tumor growth and metastasis (Drudi et al. 2012), including most of the advanced breast cancers, and some others at early stages, such as atypical hyperplasia or lobular carcinoma in situ (Drudi et al. 2012). Researchers have found that internal and surrounding vascularity on US are characteristic of malignancy (Ferrara et al. 2000; Sehgal et al. 2000), and vascular density is associated with tumor aggressiveness (Balleyguier et al. 2009). Together these sonographic features of conventional US offer relatively high accuracy in distinguishing between benign and malignant breast lesions.
Ultrasound Imaging Technologies for Breast Cancer Detection and Management: A Review
2018, Ultrasound in Medicine and BiologyCitation Excerpt :Enhancement patterns in the early phase and contrast medium persistence in the late phase differ in benign and malignant breast lesions. The features of malignancy include early and fast enhancement in the early phase, centripetal filling, claw-shaped enhancement, higher maximum intensity and contrast medium accumulation in the late phase (see Fig. 5), whereas the features of benign tissue include delayed, centrifugal filling, homogeneous enhancement and seldomly contrast medium present in the late phase (see Fig. 6) (Balleyguier et al. 2009; del Cura et al. 2005; Jung et al. 2005; Zhao et al. 2010). Since 2011, the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) guidelines for CEUS of the breast remain an important topic for research, but have not been recommended for routine clinical use (Piscaglia et al. 2012).
Modulation of mammary tumor vascularization by mast cells: Ultrasonographic and histopathological approaches
2017, Life SciencesCitation Excerpt :Although CEUS has some advantages when compared with Doppler, it is not a perfect method and present some disadvantages such as the placement of the ROI and the analysis of only one plane of the mammary tumor and not the entire lesion [57]. According to previous studies, malignant lesions showed higher maximum signal intensity (PI), fast wash-in, the wash-out is observed immediately after the peak (probably due to the presence of arteriovenous shunts and higher microvascular density) and shorter TTP; the opposite can be observed in benign lesions [52,58–60]. Due to a lack of studies on CEUS in rat models, it is not possible to establish comparisons of the data from this study with other previously obtained by other researchers.