The Hyperechoic Zone Around Breast Lesions – An Indirect Parameter of Malignancy

Abstract

Purpose: To evaluate an irregular perilesional hyperechoic zone as a potential criterion of malignancy on breast ultrasound and to test whether this zone correlates with perilesional T2 hyperintensity on magnetic resonance imaging (MRI).

Materials and Methods: A total of 137 patients (85 malignant lesions, 52 benign lesions) who underwent breast ultrasound with a 9 – 14 MHz linear broad-spectrum transducer and consecutive ultrasound-guided biopsy were included. All patients additionally underwent breast MR imaging with dedicated breast coils at 1.5 T. The protocol included a T2-weighted sequence. Perilesional hyperechoic and T2 hyperintense areas were measured by planimetry using the slice showing maximum extension of this area. The sensitivity and specificity of the perifocal area for identifying breast malignancy were determined using ROC analysis. Correlation was assessed using Pearson analysis.

Results: The presence of a hyperechoic zone identified malignancy with a sensitivity of 87 % and a specificity of 81 %. Additionally, there was a highly significant correlation of the size of the hyperechoic zone with the degree of tumor differentiation (p = 0.002) as well as with the mib-1 proliferation index (p = 0.006) and lymphangio-invasion (p = 0.02). No significant correlation was found between the hyperchoic zone and the T2 hyperintense zone on MRI (R2 = 0.16).

Conclusion: A hyperechoic zone surrounding breast lesions may serve as an additional sonomorphologic criterion of malignancy. Yet, it does not seem to correlate with edema on MRI.

Zusammenfassung

Ziel: Ziel der Studie war die Beurteilung einer irregulären hyperechogenen Zone um Mammatumoren im US als mögliches potenzielles Malignitätskriterium und zusätzlich die Prüfung der Vergleichbarkeit bzw. Übereinstimmung mit der bekannten hyperintensen Zone aus der MRT.

Material und Methoden: Insgesamt wurden 137 Patientinnen (85 maligne, 52 benigne Tumore), die eine US-Untersuchung der Brust (9 – 14 MHz Linearschallkopf) mit anschließender US-gestützter Stanzbiopsie erhielten, in die Studie eingeschlossen. Zusätzlich erhielten alle Patientinnen eine MRT der Brust (mit Brustspule, 1,5 Tesla MRT). Das Studienprotokoll beinhaltete eine T2-gewichtete Sequenz. Perifokale hyperechogene und T2 hyperintense Bereiche wurden mittels Planimetrie in der Schicht ihrer maximalen Ausdehnung vermessen. Eine ROC-Analyse wurde zum Nachweis bzw. Ausschluss von Malignität und zur Ermittlung von Sensitivität und Spezifität der perifokalen Zone durchgeführt. Eine mögliche Korrelation wurde mittels Pearson-Analyse ermittelt.

Ergebnisse: Das Vorhandensein einer hyperechogenen Zone erkannte Malignität mit einer Sensitivität von 87 % und einer Spezifizität von 81 %. Zusätzlich ergab sich eine hochsignifikante Korrelation zwischen der Größe der hyperechogenen Zone und dem Grad der Tumordifferenzierung (p = 0,002), mit der Höhe des Mib-1 Proliferationsindex (p = 0,006) und einer histologisch nachgewiesenen Lymphangioinvasion (p = 0,02). Keine signifikante Korrelation konnte zwischen der hyperechogenen Zone und der T2w hyperintensen Zone in der MRT nachgewiesen werden (R2 = 0,16).

Schlussfolgerung: Das Vorhandensein einer hyperechogenen Zone um Brustläsionen könnte als zusätzliches sonomorphologisches Malignitätskrite-rium dienen. Jedoch scheint diese nicht mit dem perifokalen Ödem aus der MRT zu korrelieren.

Key words

breast MRI - breast ultrasound - halo effect - hyperechoic zone

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