DIAGNOSTIC VALUE OF ULTRASOUND COLOR DOPPLER MAPPING IN EARLY DETECTION OF BREAST CANCER

Background. Experimental data suggest that tumor growth depends on angiogenesis. Once the tumor reaches a size of up to a 1 mм in diameter, a further increase in the population of tumor cells requires the growth of new blood vessels. In contrast to benign lesions, a rapid growth of cancer cells results in the formation of pathological vessels of different diameter and chaotic distribution. therefore, determination of the type of vascularization of lesions is an important criterion in the diagnosis of breast cancer (Bc). color Doppler mapping (cDM) is an ultrasound technology that evaluates blood floor through a blood vessel; however, according to data from a variety of literature sources, cDM is not sensitive to slow (week) blood flow as it allows the visualization of only large vessels with a diameter of at least 100 µm. The purpose of the study was to evaluate the diagnostic value of cDM in determining the type of vascularization of malignant and benign breast tumors, as well as to detect their statistically significant Doppler characteristics by comparing with histological findings. material and methods. From 2017 to 2019, a total of 277 women with complaints of breast lump or pain underwent ultrasound examination using cDM. Results. statistically and diagnostically significant us characteristics of benign lesions included the presence of avascular or hypovascular types of blood flow. the most significant characteristic of malignant lesions was the presence of hypervascular mixed blood flow. the diagnostic value of ultrasound B-mode in combination with cDM in differential diagnosis of breast tumors was as follows: 77.6 % sensitivity, 51.7 % specificity and 58.8 %. accuracy. Conclusion. statistically and diagnostically significant signs observed by cDM allow one to use this ultrasound technology in the early diagnosis of breast cancer. However, low diagnostic efficiency of cDM dictate the need to search for new ultrasonic signs.

breast cancer, early diagnosis, benign breast lesions, ultrasound, color Doppler mapping, CDm, BI-RADS system, histological evaluation, angiogenesis, vascularization

1. Semiglazov V.F., Krivorotko P.V., Dashyan G.A., Paltuev R.V. Guidelines for Doctors. Patient Management with breast cancer. Supplement Journal «Medical Council». 2017; 14; 67. (in Russian).

2. Belyaev A.M., Manikhas G.M., Merabishvili V.M. Malignant tumors in St. Petersburg and other administrative territories of the North-West Federal District of Russia (morbidity, mortality, prevalence rate, survival). Expressinformatio. Second Issue. Saint-Petersburg: 2016. 208 p. (in Russian).

3. Merabishvili V.M. Epidemiology and survival of men diagnosed with breast cancer. Problems in oncology. 2016; 62: 245–252. (in Russian).

4. Kaprin A.D., Starinsky V.V., Petrova G.V. The status of oncological assistance to the population of Russia in 2015. Moscow, 2016. 236 p. (in Russian).

5. Kaprin A.D., Starinsky V.V., Petrova G.V. Malignant neoplasms in Russia in 2015 (morbidity and mortality). Moscow, 2017. 250 p. (in Russian).

6. Weidner N., Semple J.P., Welch W.R., Folkman J. Tumor angiogenesis and metastasis-correlation in invasive breast carcinoma. New Engl J Med. 1991; 324(1): 1–8. doi: 10.1056/NEJM199101033240101.

7. Weidner N., Folkman J., Pozza F., Bevilacqua P., Allred E.N., Moore D.H., Meli S., Gasparini G. Tumor angioganesis-a new significant and independed prognostic indicator in early stage breast carcinoma. J Natn Cancer Inst. 1992; 84(24): 1875–1887. doi: 10.1093/jnci/84.24.1875.

8. Jia W.-R., Tang L., Wang D.-B., Chai W.-M., Fei X.-C., He J.-R., Chen M., Wang W.-P. Three-dimensional Contrast-enhanced Ultrasound in Response Assessment for Breast Cancer: A Comparison with Dynamic Contrast-enhanced Magnetic Resonance Imaging and Pathology. Sci Rep. 2016 Sep 22; 6: 33832. doi: 10.1038/srep33832.

9. Watanabe T., Kaoku S., Yamaguchi T., Izumori A., Konno S., Okuno T., Tsunoda H., Ban K., Hirokaga K., Sawada T., Ito T., Nakatani S., Yasuda H., Tsuruoka M., Ueno E., Tohno E., Umemoto T., Shirakawa T. Multicenter Prospective Study of Color Doppler Ultrasound for Breast Masses: Utility of Our Color Doppler Method. Ultrasound Med Biol. 2019 Jun; 45(6): 1367–1379. doi: 10.1016/j.ultrasmedbio.2019.01.02.

10. Zhang W., Xiao X., Xu X., Liang M., Wu H., Ruan J., Luo B. Non-Mass Breast on Ultrasound: Feature Exploration and Multimode Ultrasonic Diagnosis. Ultrasound Med Biol. 2018 Aug; 44(8): 1703–1711. doi: 10.1016/j.ultrasmedbio.2018.05.005.

11. Cosgrove D.O., Kedar R.P., Bamber J.C., Almurrani B., Davey J.B.N., Fisher C., McKinna J A., Svensson W.E., Tohno E., Vagios E., Alsanjari N.A. Breast diseases: color Doppler US in differential diagnosis. Radiology. 1993; 189(1): 99–104. doi: 10.1148/radiology.189.1.8372225.

12. Raza S., Baum J.K. Solid breast lesions: Evaluation with Power Doppler US. Radiology. 1997; 203(1): 164–168. doi: 10.1148/radiology.203.1.9122386.

13. Wang M., Feng H.-L., Liu Y.-Q., Liu H., Jiang Y.-X., Zhu Q.-L., Dai Q., Li J.-C.Angiogenesis Research in Mouse Mammary Cancer Based on Contrast-enhanced Ultrasonography: Exploratory Study. Acad Radiol. 2018 Jul; 25(7): 889–897. doi: 10.1016/j.acra.2017.12.004.

14. Faustino-Rocha A.I., Silva A., Gabriel J., da Costa R. M.G., Moutinho M., Oliveira P.A., Gama A., Ferreira R., Ginja M. Longterm exercise training as a modulator of mammary cancer vascularization. Biomed Pharmacother. 2016 Jul; 81: 273–280. doi: 10.1016/j.biopha.2016.04.030.

15. Kapetas P., Clauser P., Woitek R., Wengert G.J., Lazar M., Pinker K., Helbich T.H., Baltzer P.A.T. Quantitative Multiparametric Breast Ultrasound: Application of Contrast-Enhanced Ultrasound and Elastography Leads to an Improved Differentiation of Benign and Malignant Lesions. Invest Radiol. 2019 May; 54(5): 257–264. doi: 10.1097/RLI.0000000000000543.

16. Park A.Y., Seo B.K. Up-to-date Doppler techniques for breast tumor vascularity: superb microvascular imaging and contrast-enhanced ultrasound. Ultrasonography. 2018; 37(2): 98–106. doi: 10.14366/usg.17043.

17. Watanabe R., Munemasa T., Matsumura M. Contrast-enhanced ultrasound with perflubutane in the assessment of anti-angiogenic effectc: early prediction of the anticancer activity of bevacizumab in a mouse xenografted model. Ultrasound Med Biol. 2015 Sep; 41(9): 2497–505. doi: 10.1016/j.ultrasmedbio.2015.04.018.

18. D’Orsi C.J., Sickles E.A., Mendelson E.B. BI-RADS Atlas, Breast Imaging Reporting and Data System. Reston, VA, American College of Radiology, 2013.