title: Comparing contrast-enhanced color flow imaging and pathological measures of breast lesion vascularity.
abstract: 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.
authors.affiliation: Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA. flemming.forsberg@jefferson.edu
authors.forename: Flemming
authors.initials: F
authors.lastname: Forsberg
authors.forename: Babita
authors.initials: B
authors.lastname: Kuruvilla
authors.forename: Mark B
authors.initials: MB
authors.lastname: Pascua
authors.forename: Manisha H
authors.initials: MH
authors.lastname: Chaudhari
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Merton
authors.forename: Juan P
authors.initials: JP
authors.lastname: Palazzo
authors.forename: Barry B
authors.initials: BB
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001941:Breast Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001943:Breast Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D006801:Humans; D007089:Image Enhancement; D016014:Linear Models; D055806:Microvessels; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging; D010865:Pilot Projects; D011134:Polysaccharides; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508