Can Doppler or contrast-enhanced ultrasound analysis add diagnostically important information about the nature of breast lesions?

Abstract

OBJECTIVES:Despite evidence suggesting that Doppler ultrasonography can help to differentiate between benign and malignant breast lesions, it is rarely applied in clinical practice. The aim of this study was to determine whether certain vascular features of breast masses observed by duplex Doppler and color Doppler ultrasonography (before and/or after microbubble contrast injection) add information to the gray-scale analysis and support the Breast Imaging-Reporting and Data System (BI-RADS) classification.METHODS:Seventy solid lesions were prospectively evaluated with gray-scale ultrasonography, color Doppler ultrasonography, and contrast-enhanced ultrasonography. The morphological analysis and lesion vascularity were correlated with the histological results.RESULTS:Percutaneous core biopsies revealed that 25/70 (17.5%) lesions were malignant, while 45 were benign. Hypervascular lesions with tortuous and central vessels, a resistive index (RI)≥0.73 before contrast injection, and an RI≥0.75 after contrast injection were significantly predictive of malignancy (p<0.001).CONCLUSION:The combination of gray-scale ultrasonography data with unenhanced or enhanced duplex Doppler and color Doppler US data can provide diagnostically useful information. These techniques can be easily implemented because Doppler devices are already present in most health centers.

Application of a Novel Microvascular Imaging Technique in Breast Lesion Evaluation

“…Another feature of malignant lesions is the presence of penetrating vessels. Previous work on CDI and PDI supported the importance of penetrating vessels in the diagnosis of breast lesions (Gokalp et al 2009;Kwak et al 2008;Stanzani et al 2014). Penetrating vessels are significantly more common in malignant lesions and were found in 90.2% of the lesions in our study.…”

“…Newly formed vessels penetrating the lesion from the periphery to the center can be readily observed. Clinical data indicate that penetrating vessels are present in 33.8%-53.8% of malignant lesions and are found in only 14%-16.4% of benign lesions (Gokalp et al 2009;Kwak et al 2008;Stanzani et al 2014). However, such differentiation is highly dependent on the detection of low-speed flow signals in microvessels.…”

“…Conventional CDI and PDI have facilitated the diagnosis of breast lesions for more than 20 y. Consistently, these flow techniques detect more flow signals in malignant breast lesions (Blohmer et al 1999;Davoudi et al 2014;Milz et al 2001;Stanzani et al 2014), especially in the center, with more branching and irregular vessels (Milz et al 2001;Sencha et al 2013;Stanzani et al 2014). Newly formed vessels penetrating the lesion from the periphery to the center can be readily observed.…”

“…Therefore, PDI possesses greater sensitivity to the flow signals in breast lesions compared to CDI (Candelaria et al 2013;Wright et al 1998). Moreover, the introduction of contrast agents may boost flow signal detection in breast lesions (Forsberg et al 2008;Piñero et al 2003;Stanzani et al 2014) but also cause a concomitant increase in artifacts. Nevertheless, the additional cost of these agents and possible side effects should be taken into consideration.…”

“…Its descriptions of gray-scale ultrasound features are very detailed, and several researchers have reported high sensitivity and low specificity in the use of BI-RADS for categorizing breast tumors (Gokalp et al 2009). A more detailed assessment of vascularity, an important feature in the differentiation of breast lesions, seems to increase the diagnostic efficacy of gray-scale ultrasound (Gokalp et al 2009;Stanzani et al 2014). Normal breast tissues manifest little vascularity on ultrasound or alternative imaging methods.…”