To evaluate the value of ultrasonic high-definition micro-flow imaging (HD-MFI) in differentiating benign and malignant breast masses.

This was a prospective study in which all the patients were enrolled from the First Medical Center, Chinese PLA General Hospital from March 2022 to June 2022, with all masses classified as breast imaging reporting and data system (BI-RADS) 3-5 categories and confirmed by pathology. The blood flow of all masses was evaluated by color Doppler flow imaging (CDFI) and HD-MFI, respectively, and the microvascular patterns (avascular, linear, tree-like, root hair-like, and crab claw-like) of all the masses were assessed by HD-MFI. The detection of blood flow between benign and malignant masses by CDFI and HD-MFI was compared respectively, as well as the differences in microvascular patterns detected by HD-MFI. The diagnostic efficacy of CDFI and HD-MFI in the diagnosis of breast masses was assessed and compared by receiver operating characteristic (ROC) curve analysis.

A total of 114 patients with 119 breast masses were enrolled in this study, and there were 71 benign and 48 malignant masses. More Alder's grade 3 blood flow signals were detected by HD-MFI than by CDFI (72.3% vs 20.1%). On HD-MFI, both benign and malignant breast masses were mostly displayed as Alder's grades 2 and 3, and the proportion of grade 3 malignancies was higher than that of benign masses (85.4% vs 63.4%, P<0.05). Avascular, line-like, and tree-like microvascular patterns were more frequently seen in benign masses by HD-MFI, while root hair-like and crab claw-like patterns were more frequent in malignant masses (P<0.05). The diagnostic specificity (91.5% vs 81.7%), accuracy (86.6% vs 82.4%), positive predictive value (PPV) (86.4% vs 75.5%), and area under the curve [0.854 (0.777~0.912) vs 0.825 (0.745~0.889)] of HD-MFI were higher than those of CDFI.

HD-MFI is a more sensitive technique in detecting blood flow of breast masses in comparison with CDFI. HD-MFI could provide more blood flow information in differentiating benign and malignant breast masses through microvascular patterns.