title: Differentiation between benign and malignant breast tumors using kinetic features of real-time harmonic contrast-enhanced ultrasound.
abstract: BACKGROUND
  Contrast-enhanced ultrasound (CEUS) has gained interest because of its ability to gather vascular information in diverse organs. There is still a subject of debate concerning its value in breast lesions, especially as a differential diagnostic tool.
  
  
  OBJECTIVE
  To investigate whether kinetic parameters of CEUS can differentiate between malignant and benign breast lesions.
  
  
  METHODS
  We evaluated 75 malignant and 21 benign lesions in the breast or axilla. Contrast harmonic imaging (CHI) US was performed after the injection of a bolus dose of 2.4 mL of Sono Vue® (Bracco, Milano, Italy). The following parameters were calculated for kinetic analysis: initial slope, time to peak enhancement, wash-out ratios W(21) and W(50) (relative decrease in signal intensity from the peak enhancement to 21 s and 50 s, respectively).
  
  
  RESULTS
  A significant difference was found between the benign and malignant lesions in time-to-peak (P value <0.05) and wash-out ratios W(21) (P value <0.001) and W(50) (P value <0.001). The mean time-to-peak was 9.3 s for malignant and 14.6 s for benign lesions. The mean signal drop from peak to signal intensity measured at 50 s was 85% for malignant and 66% for benign lesions. There was no difference in absolute values of peak signal intensity and initial slope. The most significant difference between standardized benign and malignant wash-out curves was found at 21 s but statistical significance was reached in the range of 14-50 s.
  
  
  CONCLUSIONS
  Real-time CEUS can evolve into a new non-invasive option for differentiate malignant from benign breast lesions.
authors.affiliation: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden. ariel.saracco@sodersjukhuset.se
authors.forename: Ariel
authors.initials: A
authors.lastname: Saracco
authors.forename: Botond K
authors.initials: BK
authors.lastname: Szabó
authors.forename: Peter
authors.initials: P
authors.lastname: Aspelin
authors.forename: Karin
authors.initials: K
authors.lastname: Leifland
authors.forename: Brigitte
authors.initials: B
authors.lastname: Wilczek
authors.forename: Fuat
authors.initials: F
authors.lastname: Celebioglu
authors.forename: Rimma
authors.initials: R
authors.lastname: Axelsson
mesh_terms: D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media / Q000493:pharmacokinetics*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008327:Mammography; D008875:Middle Aged; D010743:Phospholipids / Q000493:pharmacokinetics*; D012372:ROC Curve; D018709:Statistics, Nonparametric; D013459:Sulfur Hexafluoride / Q000493:pharmacokinetics*; D016217:Ultrasonography, Mammary / Q000379:methods*
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride