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South African Medical Journal

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A contrast-enhanced ultrasound study of benign and malignant breast tissue

S Barnard, E Leen, T Cooke, W Angerson

Abstract




Objective. To determine the diagnostic value of haemodynamic contrast-enhanced ultrasound assessment in benign and malignant breast tissue, using histological examination as the reference standard.
Methods. An HDI 5000 Phillips ultrasound scanner with microvascular imaging software and 2.5 ml SonoVue (Bracco spa, Milan) contrast was used to scan 50 consecutive patients
(32 malignant and 18 benign, 49 with histologically confirmed breast lesions). Time-intensity curves of the regions of interest (ROI) placed over the lesional and normal breast tissues were acquired using QLAB software. The area under the curve (AUC), time to peak (TTP), in-flow gradient (IFG) and peak enhancement (PE) were determined in a standardised manner
for each focal breast lesion and the control/normal breast. IFG and AUC in the periphery, and PE and AUC in the centre of the lesions, differed significantly between malignant and
benign tumours. In a logistical regression model, AUC in the periphery and the ratio of PE at the tumour centre to that of normal breast were independently predictive of malignancy
(p<0.001), achieving a diagnostic sensitivity of 97% and a specificity of 80% in the 41 tumours in which central vessels could be distinguished.
Conclusion. Haemodynamic contrast-enhanced ultrasound assessment can be used to distinguish between benign and malignant breast lesions.

South African Medical Journal Vol. 98 (5) 2008 pp. 386-391



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