Microvascular architecture of breast lesions: evaluation with contrast-enhanced ultrasonographic micro flow imaging

The purpose of this study was to evaluate the effectiveness of micro flow imaging (MFI) of the microvascular architecture with contrast-enhanced ultrasonography for classification of breast lesions as benign or malignant and the microvascular architectural patterns.

Contrast-enhanced ultrasonography and MFI were performed in 61 women with breast lesions. The microvascular morphologic and distribution features of the breast tumors were evaluated with MFI. Receiver operating characteristic curve analysis was used to evaluate the diagnostic value of MFI, and the microvascular architectural patterns were analyzed.

Surgical pathologic analysis showed 29 benign and 32 malignant lesions. For MFI, the area under the receiver operating characteristic curve (A(z)) value for the overall features of the blood vessels for classification of breast lesions was 0.94. The accuracy, sensitivity, and specificity were 90.2% (55/61), 93.8% (30/32), and 86.2% (25/29), respectively. The A(z) value for the morphologic and distribution features of peripheral blood vessels was 0.91, which was significantly higher than the A(z) value for the morphologic and distribution features of interior vessels (P= .019). The microvascular architecture of the 61 lesions was categorized into 3 patterns: treelike, root hair-like, and crab claw-like. Benign lesions mainly displayed the treelike pattern (17 [58.6%]); malignant lesions tended to display the crab claw-like pattern (20 [62.5%]); and the root hair-like pattern was shown in both benign and malignant lesions (11 [37.9%] and 8 [25%], respectively). The microvascular architecture showed significant differences between benign and malignant lesions (P< .001).

Micro flow imaging can clearly delineate the microvascular architecture of breast lesions and can aid in discrimination between benign and malignant breast lesions.