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Contrast enhanced ultrasound (CEUS) of impalpable breast lesions.


Authors: K. Dvořák;  V. Válek;  J. Patera;  M. Třináctá;  E. Jandáková;  Z. Pačovský;  M. Kuzárová;  R. Jakubcová;  J. Foukal
Authors‘ workplace: Fakultní nemocnice Brno, Česká republika
Published in: Prakt Gyn 2009; 13(4): 202-212

Overview

Aim:
The main aim of this pilot project was to determine benefits and assess sensitivity/ specificity of contrast enhanced ultrasound (CEUS) using 2nd generation contrast agent SONOVUE® for detection of impalpable breast lesions with mammography and native ultrasound with Doppler examination as references and with histological verification of lesions [6– 10]. The secondary aim was to assess the value of CEUS in monitoring the outcomes of neoadjuvant chemotherapy (a group of 15 patients with lobular carcinoma).

Methods:
The total amount of 2,4 ml of contrast agent SONOVUE® followed by lavage with 5 ml of saline was administered to 126 patients (63 malignant and 63 benign lesions); histological examination was carried out in both groups of women. Sonography was performed with iU22 Philips and L 9– 3 MHz linear probe, in harmonic mode using microvascular imaging and QLAB® software. The low mechanical index of 0,07 was used for early microbubble destruction and to obtain optimal image quality. Vascular signs, microvascular architecture, number of vessels [1– 5], degree of enhancement, time intensity curves together with area under the curve (AUC), time to peak (TTP), in‑flow gradient (IFG), peak enhancement (PE) and out‑ flow gradient (OFG –  contrast wash out time) were obtained using QLAB software, 5 mm ROI (region of interest) was positioned in the centre of a lesion and 1 cm away from the lesion in an intact parenchyma. The CEUS results were processed statistically together with all diagnostic imaging techniques.

Results:
The obtained results provided statistically significant differentiation of benign and malignant lesions. Sensitivity of CEUS in the malignant lesions group was 98% and specificity 92 %, sensitivity in the benign lesions group was 89 % and specificity 82 %

Key words:
contrast enhanced ultrasound –  CEUS –  Doppler examination –  SonoVue® –  harmonic image –  QLAB –  mammography –  histology


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