The Super Resolution Ultrasound in Visualizing Interstitial-Lymphatic Network in Breast Tumors: A Clinical Pilot Application.

RATIONALE AND

OBJECTIVES

The interstitial-lymphatic network (ILN) is critical in cancer development, metastasis, and treatment. This study aimed to investigate characteristics of ILN in different types of breast tumor using Super-Resolution Ultrasound (SRUS).

MATERIALS AND

METHODS

This prospective study was conducted from January 2024 to March 2024 in a tertiary referral hospital. A total of 192 patients hospitalized for breast lesions (including 54 benign and 138 malignant tumors) were enrolled. SRUS was performed by injecting contrast agents into tumor interstitial space. Parameters derived from SRUS images were compared in different breast tumors using chi-square, t-tests and non-parametric tests as appropriate.

RESULTS

Compared with benign tumor, malignant lesions exhibited significantly lower vessel density, flow velocity, and vessel ratio (p<0.001) and more often exhibited peripheral, heterogeneous ILN patterns with loss of branch-like networks (p < 0.001). Structurally, the complexity level and the maximum curvature values of ILN in breast cancers were significantly lower than benign breast tumors (p < 0.05). The difference of ILN diameters and the mean distance in the long axis of tumors also showed significance in two groups (p < 0.05). In Non-Luminal breast cancer, the ILN density were higher than in Luminal breast cancer (p ≤ 0.01 for all). Moreover, the distance standard deviation of ILN was significantly smaller than that of without sentinel lymph node metastases (p < 0.05).

CONCLUSION

SRUS effectively visualized the ILN in breast tumors at micron-scale resolution, revealing distinct morphological and hydrodynamic patterns across different types of breast tumors.