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.

Figure 1

A fibroadenoma found in the left breast of a 47-year-old woman. A) Gray-scale image showing an irregular, microlobulated mass (BI-RADS 4). B) Color Doppler image showing a peripheral regular artery. C) After contrast injection, we observed moderate peripheral enhancement. D) An enhanced color Doppler image showing the same aspect as that shown for the non-enhanced color Doppler image in B. No additional arteries were observed. Power Doppler imaging was used only to produce clearer images for illustration purposes.

Figure 2

An invasive ductal carcinoma recurrence in the left breast of a 63-year-old woman. A) A gray-scale image showing an irregular, spiculated mass with an echogenic halo, architectural distortion, acoustic shadowing, and straightening of Cooper's ligament (BI-RADS 5). B) A color Doppler image showing an avascular lesion. C) After contrast injection, there was minimal enhancement. D) An enhanced color Doppler image showing an avascular lesion.

Figure 3

An invasive ductal carcinoma in the right breast of a 71-year-old woman. A) A gray-scale image showing an irregular, microlobulated mass with an echogenic halo and acoustic shadowing (BI-RADS not 3). B) A color Doppler image showing a hypervascular lesion with central and irregular arteries. C) After contrast injection, there was intense enhancement. D) An enhanced color Doppler image showed the same pattern as the unenhanced CDUS. Power Doppler imaging was used only to produce clearer images for illustration purposes.

Figure 4

Juvenile fibroadenoma in the left breast of an 18-year-old woman. A) A gray-scale image showing an oval, circumscribed mass (BI-RADS 3). B) A color Doppler image showing a hypervascular lesion with central and regular arteries. C) An enhanced color Doppler image showed the same pattern as the unenhanced CDUS. Power Doppler imaging was used only to produce clearer images for illustration purposes. D) After contrast injection, there was intense enhancement.