Cancer Management and Research (Mar 2020)
The Vascular Index of Superb Microvascular Imaging Can Improve the Diagnostic Accuracy for Breast Imaging Reporting and Data System Category 4 Breast Lesions
Abstract
Si-Man Cai,1 Hong-Yan Wang,1 Xiao-Yan Zhang,1 Li Zhang,1 Qing-Li Zhu,1 Jian-Chu Li,1 Qiang Sun,2 Yu-Xin Jiang1 1Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing 100730, People’s Republic of China; 2Department of Breast Surgery, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing 100730, People’s Republic of ChinaCorrespondence: Hong-Yan WangDepartment of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy Medical Sciences, N0.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, People’s Republic of ChinaTel/Fax +86 10-69155494Email [email protected]: To investigate whether the vascular index (VI) of superb microvascular imaging (SMI) could improve the diagnostic efficiency for BI-RADS 4 breast lesions and reduce the number of unnecessary biopsies.Patients and Methods: For this study, we selected 222 consecutive BI-RADS 4 breast lesions detected by ultrasound and confirmed by pathology from January 2016 to October 2018. A VI of 4.0 was set as the cutoff value to degrade BI-RADS classification. We calculated the accuracy, sensitivity and PPV of a BI-RADS diagnosis alone and the combination of BI-RADS and the VI.Results: Pathologically, of the 222 lesions, 129 were confirmed to be benign, and 93 were found to be malignant. A VI of 4.0 was set as the cutoff value; when the VI≤ 4.0, those BI-RADS 4 masses were downgraded one level (4C-4B, 4B-4A, 4A-3) to an integral BI-RADS grade, while the others maintained the conventional grade. A total of 54 BI-RADS 4 lesions were degraded to BI-RADS 3, including 53 benign lesions and 1 malignant lesion. The diagnostic accuracy (65.3% vs 41.9%) and PPV (54.8% vs 41.9%) were significantly improved. The sensitivity decreased slightly (98.9% vs 100%) because 1 of the 54 downgraded BI-RADS 4 lesions, which had a pathological type of invasive ductal carcinoma, was incorrectly downgraded.Conclusion: SMI is a noninvasive tool for visualizing the vascular structure with high-resolution microvascular images. As a quantitative index, the VI can be used to appropriately downgrade benign lesions classified as BI-RADS 4, which can improve the diagnostic accuracy and PPV and reduce unnecessary biopsies.Keywords: superb microvascular imaging, breast neoplasms, ultrasonography, diagnostic imaging
