Evaluation of solid breast lesions with power Doppler: value of penetrating vessels as a predictor of malignancy

Abstract

Introduction: This study aimed to evaluate the vascular pattern of solid breast lesions using power Doppler ultrasonography (PDUS) and assess whether the presence of intratumoural penetrating vessels can predict breast cancer malignancy.

Methods: Greyscale ultrasonography (US) and PDUS were prospectively performed on 91 women in Malaysia with histopathologically proven breast lesions. The diagnostic accuracy of greyscale US, PDUS, and both greyscale US and PDUS was calculated and compared.

Results: The 91 women had 102 breast lesions (55 benign, 47 malignant). Of the 47 malignant lesions, 36 demonstrated intratumoural penetrating vessels. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of greyscale US findings in diagnosing malignancy were 100.0%, 71.4%, 74.1% and 100.0%, respectively. The presence of calcification in the breast lesion and the margin, shape and posterior acoustic features of the lesion were significant parameters in predicting malignancy (p < 0.01). The sensitivity, specificity, PPV and NPV of the presence of intratumoural penetrating vessels in predicting malignancy were 76.5%, 80.0%, 76.5% and 80.0%, respectively. When both greyscale US and PDUS were used, there was a significant correlation in predicting malignancy (p < 0.05). The specificity and PPV values of the combined greyscale US and PDUS method (89.0% and 85.7%, respectively) were higher than those of greyscale US or PDUS alone.

Conclusion: Flow patterns revealed by PDUS can be useful for differentiating benign and malignant breast lesions. The visualisation of penetrating vessels in solid breast lesions can be used to complement greyscale US findings in predicting malignancy.

Keywords: breast cancer; penetrating vessel; power Doppler; ultrasonography.

Fig. 1

Power Doppler US image shows vascular flow at the centre and along the periphery of the mass (arrows).

Fig. 2

Power Doppler US image shows penetrating vessels in an irregular hypoechoic mass. The vessels are seen coursing into the mass (arrows).

Fig. 3

Power Doppler US image shows how the variables, Depth 1 and Depth 2, are measured to calculate the degree of vascular penetration. A line is drawn at the superficial margin of the lesion (white arrow), perpendicular to the point of entry of the penetrating vessel. Another line is then drawn, parallel to the previous line at the point where the penetrating vessel ends (black arrow). Depth 1 (white arrowhead), which is the depth/length of the penetrating vessel in the lesion, is the distance between the two parallel lines. Depth 2 (black arrowhead) is the depth of the lesion.

Fig. 4

Flow chart shows the classification of the patients’ breast lesions when both B-mode greyscale ultrasonography (US) and power Doppler US (PDUS) were used (n = 102).

Fig. 5

An invasive ductal carcinoma in the right breast of a 51-year-old woman. (a) B-mode greyscale US image shows an irregular hypoechoic mass with spiculated margins. The mass appears to have a taller-than-wide (non-parallel) orientation with associated architectural distortion (white arrows). (b) Power Doppler US image shows linear penetrating vessels traversing the mass (black arrows).

Fig. 6

An invasive ductal carcinoma in the right breast of a 55-year-old woman. (a) B-mode greyscale US image shows an irregular 3 cm solid hypoechoic mass with microlobulated margins (black arrows). Minimal posterior shadowing is also seen. This mass was interpreted as a highly suspicious lesion (i.e. categorised as BI-RADS 5). (b) Power Doppler US image shows vessels penetrating into the mass (white arrows).

Fig. 7

A lesion in the right breast of a 47-year-old woman who presented with a palpable right breast mass. (a) B-mode greyscale US image shows an irregular hypoechoic lesion that has a taller-than-wide orientation (white arrows) and spiculated margins. (b) Power Doppler US image shows peripheral and branching penetrating vessels in the lesion (black arrows). The lesion was histopathologically diagnosed as an invasive ductal carcinoma.