The Use of Unenhanced Doppler Sonography in the Evaluation of Solid Breast Lesions

Abstract

Del cura et al studied the doppler parameters in solid breast lesions and based on that postulated that doppler alone was not a good modality in determining malingancy of a lesion. However the detection of null or reversed diastolic flow on spectral Doppler imaging is an infrequent but highly consistent finding in malignant lesions.

Evaluation of Doppler Spectral Indices As ‘Tests’ with High Sensitivity for the Provisional Diagnosis of Malignancy in Solid Breast Masses and the Recruitment of Cases for Confirmatory Tests

“…The one case in the present study with PI greater than 4 was found to be malignant. There is overlap between the value ranges of RI in benign and malignant groups, in the present study, similar to that of delCura et al 12 The efficacy of RI in diagnosing malignancy is assessed in the present study; when a value of RI equal to or greater than 0.8, as suggested by del Cura et al 12 is used to differentiate malignant tumours from benign ones, the following statistical figures are obtained -sensitivity (38.9%), specificity (100%), positive predictive value (100%) and negative predictive value (37.1.6%); the article by del Cura et al had not mentioned using ROC analysis and likelihood ratio. It is obvious that the sensitivity is unacceptably low and this cutoff value cannot be used in Doppler studies, which are used as as screening tools.…”

“…All these parameters are excellent for a 'screening test'with high sensitivity and this study proposes a cut-off value of 0.66 for RI for the purpose of selecting cases that need biopsy (the gold standard). The article by delCura et al 12 suggesting a cut-off RI value of 0.8 has not mentioned about having carried out ROC analysis. An RI, equal to or greater than one, had poor sensitivity (8.3%) and negative predictive value (28.3%) but very high specificity (100%) and positive predictive value (100%).…”

“…The cut-off points of 1.4 and 0.8 for PI and RI, respectively, have been put forward for this purpose by del Cura et al; these investigators have obtained at least 80% specificity and relatively high sensitivity and positive predictive value for an impression of malignancy in breast masses showing PI or RI values equal to or greater than the 'cut off' values mentioned above. 12 However, the current role of gray scale and colour Doppler ultrasound is to identify lesions requiring FNAC/biopsy i.e., that of a 'screening test' which should have high sensitivity, even at the cost of specificity. The present study is an attempt to evaluate the efficiency of various Doppler parameters including morphological parameters of vascularity and the conventional Doppler spectral indices in differentiating the malignant lesions from the benign ones among the palpable solid masses of breast and to identify a set of cut-off values of the spectral indices giving high sensitivity for malignancy and thus can recruit cases for FNAC/biopsy.…”

Combined contrast-enhanced power Doppler and real-time sonoelastography performed during EUS, used in the differential diagnosis of focal pancreatic masses (with videos)

“…[39][40][41][42][43][44] The same approach proved useful in the current study for the differentiation between benign and malignant focal pancreatic masses, with very good specificity (88.2%) and PPV (92%). However, this approach has certain limitations because several measurements were done inside the intratumoral vessels after contrast-enhancement with SonoVue, with the highest value recorded, with previous data showing large intraobserver variability between measured indices.…”

Validity of Gray Scale Sonography along with Color Doppler Spectral Analysis for the detection of Malignant Breast Tumour

“…Color Doppler Ultrasonography is very useful in the differentiation between benign and malignant breast masses.The criteria that the presence of intratumoral or peripheral blood flow on Color Doppler indicated the existence of malignant disease and the absence of such flow in benign disease yielded promising results in early research. However, the detection of vessels on the inside of a breast nodule is significantly linked with malignancy 5 .Evaluation of the spatial distribution of vessels and ability to resolve spectral analysis may add valuable information to the imaging based diagnostic work-up of indeterminate Solid breast lesions. Breast malignancies have higher resistance indices assessed by color-coded Doppler ultrasound than benign lesions6.Choi et al 1 also attempted to evaluate the significance of resistive index (RI) in differentiating between benign and malignant breast lesions on Color Doppler Examination.…”