# The Role of Monochromatic Superb Microvascular Index to Predict Malignancy of Solid Focal Lesions: Correlation Between Vascular Index and Histological Bioptic Findings

## TL;DR

This study shows that the ultrasound-based mSMI vascular index can help predict if a solid lesion is cancerous by comparing it to biopsy results.

## Contribution

The study introduces mSMI as a novel, non-invasive tool for predicting malignancy in solid lesions with high diagnostic accuracy.

## Key findings

- Malignant lesions had a significantly higher vascular index (35.45%) compared to benign lesions (11%).
- A threshold VI value of 15.4% effectively differentiated malignant from benign lesions.
- The mSMI achieved an overall diagnostic accuracy of 0.878 in predicting malignancy.

## Abstract

Objectives: This study aims to assess the potential role of the ultrasound (US) monochromatic Superb Microvascular Index (mSMI) to predict malignancy of solid focal lesions, correlating the vascular index (VI) with bioptic histological results. Methods: In this single-center retrospective analysis, patients undergoing percutaneous US-guided biopsy of solid lesions were considered. Biopsy indication was given by a multidisciplinary team evaluation based on clinical radiological data. Exclusion criteria were: unfeasible SMI evaluations due to poor respiratory compliance, locations not appreciable with the SMI, previous antiangiogenetic chemo/immunotherapies, and inconclusive histological reports. The mSMI examination was conducted in order to visualize extremely low-velocity flows with a high resolution and high frame rate; the VI was semi-automatically calculated. All bioptic procedures were performed under sole US guidance using 16G or 18G needles, immediately after mSMI assessment. Results: Forty-four patients were included (mean age: 64 years; 27 males, 17 females). Liver (15/43), kidneys (9/43), and lymph nodes (6/43) were the most frequent targets. At histopathological analysis, 7 lesions were benign and 37 malignant, metastasis being the most represented. The VI calculated in malignant lesions was statistically higher compared to benign lesions (35.45% and 11% in malignant and benign, respectively; p-value 0.013). A threshold VI value of 15.4% was identified to differentiate malignant lesions. The overall diagnostic accuracy of the VI with the mSMI was 0.878, demonstrating a high level of diagnostic accuracy. Conclusions: In this study, the mSMI analysis of solid focal lesions undergoing percutaneous biopsy significantly correlated with histological findings in terms of malignant/benign predictive value, reflecting histological vascular changes in malignant lesions.