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The Vascular Index of Superb Microvascular Imaging Can Improve the Diagnostic Accuracy for Breast Imaging Reporting and Data System Category 4 Breast Lesions

Authors Cai SM, Wang HY, Zhang XY, Zhang L, Zhu QL, Li JC, Sun Q, Jiang YX

Received 12 December 2019

Accepted for publication 27 February 2020

Published 11 March 2020 Volume 2020:12 Pages 1819—1826


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Kenan Onel

Si-Man Cai,1 Hong-Yan Wang,1 Xiao-Yan Zhang,1 Li Zhang,1 Qing-Li Zhu,1 Jian-Chu Li,1 Qiang Sun,2 Yu-Xin Jiang1

1Department of Medical Ultrasound, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing 100730, People’s Republic of China; 2Department of Breast Surgery, Peking Union Medical College Hospital and Chinese Academy Medical Sciences, Beijing 100730, People’s Republic of China

Correspondence: Hong-Yan Wang
Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy Medical Sciences, N0.1 Shuai Fu Yuan, Dong Cheng District, Beijing 100730, People’s Republic of China
Tel/Fax +86 10-69155494

Purpose: To investigate whether the vascular index (VI) of superb microvascular imaging (SMI) could improve the diagnostic efficiency for BI-RADS 4 breast lesions and reduce the number of unnecessary biopsies.
Patients and Methods: For this study, we selected 222 consecutive BI-RADS 4 breast lesions detected by ultrasound and confirmed by pathology from January 2016 to October 2018. A VI of 4.0 was set as the cutoff value to degrade BI-RADS classification. We calculated the accuracy, sensitivity and PPV of a BI-RADS diagnosis alone and the combination of BI-RADS and the VI.
Results: Pathologically, of the 222 lesions, 129 were confirmed to be benign, and 93 were found to be malignant. A VI of 4.0 was set as the cutoff value; when the VI≤ 4.0, those BI-RADS 4 masses were downgraded one level (4C-4B, 4B-4A, 4A-3) to an integral BI-RADS grade, while the others maintained the conventional grade. A total of 54 BI-RADS 4 lesions were degraded to BI-RADS 3, including 53 benign lesions and 1 malignant lesion. The diagnostic accuracy (65.3% vs 41.9%) and PPV (54.8% vs 41.9%) were significantly improved. The sensitivity decreased slightly (98.9% vs 100%) because 1 of the 54 downgraded BI-RADS 4 lesions, which had a pathological type of invasive ductal carcinoma, was incorrectly downgraded.
Conclusion: SMI is a noninvasive tool for visualizing the vascular structure with high-resolution microvascular images. As a quantitative index, the VI can be used to appropriately downgrade benign lesions classified as BI-RADS 4, which can improve the diagnostic accuracy and PPV and reduce unnecessary biopsies.

Keywords: superb microvascular imaging, breast neoplasms, ultrasonography, diagnostic imaging

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