Efficacy of Spectral Doppler Indices in Predicting Malignancy in BI-RADS 3 Breast Lesions: A Prospective Cohort Study

Abstract

Introduction: Breast Imaging, Reporting and Data System (BI-RADS) is an effective tool for management of patients with breast pathologies. While the BI-RADS 1 (negative) and BI- RADS 2 (benign) categories patients are advised for routine mammography screening. BI-RADS 4 (suspicious abnormality) and BI-RADS 5 (highly suggestive of malignancy) categories patients are recommended for tissue diagnosis, BI-RADS 3 category patients are managed with follow-up examinations. But upto 2% of BI-RADS 3 lesions are proved to be malignant on follow-up examinations and tissue diagnosis. Aim: To evaluate the efficacy of spectral Doppler indices in predicting malignancy in BI-RADS 3 category breast lesions. Materials and Methods: A prospective cohort study was conducted in the Department of Radiology, Katuri Medical College, Guntur, Andra Pradesh, India from July 2019 to February 2021. Study was conducted on 292 BI-RADS 3 lesions from 257 patients to evaluate the efficacy of spectral Doppler indices in differentiating malignant BI-RADS 3 lesions from benign ones. All the breast masses were evaluated with spectral doppler and the resistive and pulsatility indices were compared with histopathology findings of the suspicious lesions detected in follow-up examinations. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) 2017 version 25, and the quantitative data was expressed in mean and standard deviation. Results: The patients recruited in the study were in age range of 27-80 years, and the mean age of the patients was 46±15 years (mean±SD). Follow-up examinations and tissue diagnosis of suspicious lesions revealed 8 out of 292 BI-RADS breast masses to be malignant. On spectral Doppler analysis, high resistivity and pulsatility indices are predictive of malignancy. A resistive index of more than 0.6 as a sign of malignancy proved to have a sensitivity of 87.5% and specificity of 85.5% and more than 0.8 as a sign of malignancy has a sensitivity of 25% and specificity of 95%. A pulsatility index of more than 0.9 as a sign of malignancy has a sensitivity of 87.5% and specificity of 87% and more than 1.6 as a sign of malignancy has a sensitivity of 37.5% and specificity of 96%. Conclusion: Spectral doppler is reliable in the prediction of malignancy of BI-RADS 3 breast masses.