Objective:

To explore the value of superb microvascular imaging (SMI) in improving tumor microvasculature imaging and the accuracy of ultrasound guided puncture biopsy in children with retroperitoneal neuroblastoma (NB).

Methods:

This retrospective study involved the analysis of the clinical data

tumor

ultrasound imaging

and ultrasound-guided puncture biopsy results of 24 children with unresectable retroperitoneal NB in Xinhua Hospital

Shanghai Jiao Tong University School of Medicine from March 2015 to July 2021. The tumor microvasculature was assessed by measuring the percentage of tumor flow area within the region of interest blood flow area ratio (BFAR ) by Image J software. The biopsy adequacy rate of SMI targeted biopsy was evaluated using biopsy histopathology as reference standard. The Expert Consensus on Diagnosing and Treating Neuroblastoma in Children (CCCG-NB-2015 Regimen)

tumor biomarker and surgical histopathology after chemotherapy were used to assess the accuracy of SMI targeted biopsy.

Results:

The BFAR value of SMI was significantly higher than that of the color Doppler flow imaging and color Doppler energy imaging (14.74%

3.17%

5.88%

respectively

P

＜0.001). All 24 SMI targeted biopsy procedures successfully confirmed the diagnosis of NB

with 83.3% adequate for subtype classification and 100.0% adequate for

MYCN

gene amplification analysis. Among the 20 patients with tumor subtypes confirmed on biopsy

18 of them were categorized to partial response and 2were categorized to stable disease. Among the 4 patients whose tumor subtype could not be confirmed on biopsy

2 of them were categorized to partial response and the rest 2 were categorized to stable disease.

Conclusion:

With significant improvement in the depiction of tumor vasculature

SMI guided puncture biopsy is of great importance in improving the accuracy of histopathology results

especially for tumor subtype classification and genetic alternation.