shu-508 and Breast-Diseases

To evaluate the effects of a new microbubble contrast agent for ultrasound (US) on breast masses.. Thirty-four patients underwent color Doppler US before and after intravenous injection of a "contrast agent" containing microbubbles. The authors subjectively evaluated the increase in intensity of the Doppler signals, the changes in the vascular patterns, and the timing of the transit of the microbubble bolus. The diagnostic confidence was assessed before and after administration of contrast material.. After contrast material injection, there was greater and longer signal enhancement in the cancers than in the benign lesions. The cancers displayed characteristic vascular morphologic features, with more additional vessels visualized in relation to the lesion and a greater increase in vascular tortuousity. Shunts between vessels were demonstrated in all cancers but were not seen in any benign lesion. The diagnostic confidence increased with use of the contrast agent. The appearance at contrast-enhanced US led to a change in the US diagnosis in four patients. This increased both sensitivity and specificity to 100%.. Injection of a microbubble agent enabled accurate differentiation of benign masses from carcinomas.

Topics: Adult; Aged; Breast Diseases; Breast Neoplasms; Contrast Media; Diagnosis, Differential; Female; Humans; Injections, Intravenous; Middle Aged; Polysaccharides; ROC Curve; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Mammary

This study was conducted to compare quantifiable measures of vascularity obtained from contrast-enhanced color flow images of breast lesions to pathologic vascularity measurements. Nineteen patients with solid breast masses received Levovist Injection (10 mL at 300 mg/mL; Berlex Laboratories, Montville, NJ, USA). Color flow images of the mass pre and post contrast were obtained using an HDI 3000 scanner (Philips Medical Systems, Bothell, WA, USA) optimized for clinical scanning on an individual basis. After surgical removal, specimens were sectioned in the same planes as the ultrasound images and stained with an endothelial cell marker (CD31). Microvessel area (MVA) and intratumoral microvessel density (MVD) were determined for vessels 10-19 microm, 20-29 microm, 30-39 microm, 40-49 microm and > or =50 microm in diameter using a microscope and image processing software. From the ultrasound images, the number of color pixels before and after contrast administration relative to the total area of the breast mass was calculated as a first-order measure of fractional tumor vascularity. Vascularity measures were compared using reverse stepwise multiple linear regression analysis. In total, 58 pathology slides (with 8,106 frames) and 185 ultrasound images were analyzed. There was a significant increase in flow visualization pre to post Levovist injection (p = 0.001), but no differences were found between the 11 benign and the eight malignant lesions (p > 0.35). Ultrasound vascularity measurements post contrast correlated significantly with pathology (0.15 < or = r2 < or = 0.46; p < 0.03). The 30-39 microm vessel range contributed most significantly to the MVD relationship (p < 0.001), whereas the MVA was mainly influenced by vessels 20-29 microm (p < 0.004). Precontrast ultrasound only correlated with pathology for relative MVA (r2 = 0.16; p = 0.01). In conclusion, contrast-enhanced color flow imaging provides a noninvasive measure of breast tumor neovascularity, corresponding mainly to vessels 20-39 microm in diameter, when used in a typical clinical setting.

Topics: Adult; Aged; Aged, 80 and over; Blood Flow Velocity; Breast Diseases; Breast Neoplasms; Contrast Media; Female; Humans; Image Enhancement; Linear Models; Microvessels; Middle Aged; Neovascularization, Pathologic; Pilot Projects; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Mammary; Young Adult

To evaluate the potential diagnostic value of quantification of contrast enhanced power Doppler sonography in breast lesions.. Before and after bolus application of 300 mg/ml of the contrast agent Levovist (Schering, Germany), 76 randomly selected equivocal breast lesions (37 benign, 39 malignant) underwent power Doppler sonography. The data were acquired with a 7.5 MHz linear array transducer (Sonoline Versa Pro and Sonoline Elegra Plus, Siemens, Germany). Following postprocessing digitalization, color pixel density (CPD) and dynamic contrast enhancement were calculated and compared using different regions of the tumor (entire lesion, center and periphery).. A measurable pixel signal prior to the application of the contrast agent was observed in 12 of 37 benign and in 18 of 39 malignant lesions (32.4 % and 46.2 %, respectively). After administration of the contrast agent, the lesions with measurable signal increased to 20 of 37 (54 %) and 25 of 39 (64.1 %), respectively. No statistically significant difference of dignity-related signal intensity could be verified before or after administration of the contrast agent. Maximum CPD and relative increase in pixel density after contrast medium was appreciably higher in the center of malignant lesions than in corresponding regions of benign lesions.. Quantification of color pixel density is rather nonspecific for the discrimination of equivocal breast lesions and not suitable for clinical routine. Signal detection and quantification of color coded pixels enable comparison of dynamic contrast enhancement.

Topics: Adult; Aged; Aged, 80 and over; Breast Diseases; Breast Neoplasms; Contrast Media; Diagnosis, Differential; Female; Humans; Image Processing, Computer-Assisted; Mathematical Computing; Middle Aged; Neovascularization, Pathologic; Polysaccharides; Prospective Studies; Regional Blood Flow; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Mammary

To evaluate power Doppler ultrasonography (US) performed with a microbubble US contrast agent in the differentiation of nonpalpable breast lesions.. Fifty nonpalpable breast lesions in 50 patients were prospectively evaluated with power Doppler US before and after injection of the contrast agent SH U 508A. Lesion vascularity and the morphology of vessels on US scans were analyzed and were correlated with histologic results.. Surgical excision revealed 22 cancers and 28 benign lesions. At nonenhanced power Doppler US, eight (36%) of 22 cancers and four (14%) of 28 benign lesions were vascular. At contrast agent-enhanced power Doppler US, 21 (95%) cancers and six (21%) benign lesions were vascular (P <.001). Irregular vessels were seen in three cancers and one benign lesion at nonenhanced power Doppler US and in 11 cancers and one benign lesion at contrast-enhanced power Doppler US. By using the presence of vascularity in the mass as the diagnostic criterion for malignancy, the sensitivity, specificity, and positive and negative predictive values of power Doppler US changed from 36%, 86%, 67%, and 63%, respectively, to 95%, 79%, 78%, and 96% after contrast agent injection.. Contrast-enhanced power Doppler US was superior to nonenhanced power Doppler US in the demonstration and characterization of tumor vascularity in nonpalpable breast lesions. Contrast-enhanced power Doppler US may be useful for the differentiation between nonpalpable breast cancers and benign tumors.

Topics: Adult; Aged; Breast Diseases; Chi-Square Distribution; Contrast Media; Diagnosis, Differential; Evaluation Studies as Topic; Female; Humans; Middle Aged; Neovascularization, Pathologic; Polysaccharides; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Treatment Outcome; Ultrasonography, Doppler; Ultrasonography, Mammary

At the women's hospital of the University of Erlangen we performed a prospective clinical study to evaluate the use of color Doppler imaging supported by the new echo contrast agent Levovist in comparison to clinical examination, B-mode sonography, mammography, and MRI. In 40 patients the sensitivity and specificity of each method was estimated in predicting the dignity of palpable or mammographically detectable tumors of the breast. Prior to and after administration of Levovist we recorded the number of vessels, the PI, RI, SD-ratio, and maximum flow velocity after correction of the angle. Color Doppler imaging of the tumor and the surrounding tissue was documented on video tape for five minutes after the administration of Levovist. We measured the time until an increase and decrease in color signal was detectable. The following sensitivities/specificities were found: clinical examination 57.1% (12/21)/73.7% (14/19), B-mode sonography 100% (21/21)/84.2% (16/19), mammography 100% (21/21)/89.5% (17/19) and MRI 92.3% (14/15)/78.6% (15/18). Without the contrast agent color Doppler imaging could not differentiate between malignant and benign lesions. There was no significant difference in the perfusion of benign and malignant tumors. However, after the administration of Levovist, there appeared to be a significant difference for SD-ratio. With a cut-off-level of 3.5 we found a sensitivity/specificity of 85% (17/ 20)/78.6% (11/14) for the Doppler method. There was a weak correlation between the time of appearance of the augmented Signal in color Doppler and the velocity of enhancement of the contrast agent in MRI (n = 24, r = 0.47, p = 0.02). Only with the use of a contrast agent was color Doppler ultrasound able to support the other methods in pre-operative differentiation of benign and malignant lesions in the breast.

Topics: Adult; Aged; Aged, 80 and over; Breast Diseases; Breast Neoplasms; Contrast Media; Diagnosis, Differential; Female; Humans; Middle Aged; Polysaccharides; Radiography; Ultrasonography, Doppler, Color