Role of Colour Doppler for Assessment of Malignancy in Solid Breast Masses: A Prospective Study

Abstract

Introduction: Mammography and ultrasound are the commonly used modalities for radiological evaluation of breast masses and assessment of aggressive features that point towards malignancy. Colour Doppler provides vital information about the vascularity of solid breast masses. Neoangiogenetic vascular architecture of the solid breast lesions can be depicted reliably on colour Doppler, some differentiating features of benign and malignant breast masses on colour Doppler can also provide additional critical information for the assessment of malignancy. Aim: To assess the role of colour Doppler ultrasound in differentiating benign and malignant breast masses and to ascertain the predictive value of colour Doppler in predicting malignancy grade in FNAC proven malignant breast masses. Materials and Methods: We prospectively studied features of Doppler ultrasound on 173 treatment-naïve solid breast masses in 148 patients diagnosed in our institution. Doppler ultrasound findings of all these masses were evaluated using colour, power and spectral Doppler. Cytological analysis of all the masses was done by Fine Needle Aspiration Cytology (FNAC). Various colour Doppler parameters were correlated with findings on FNAC. Total 52 malignancies of the breast were detected and each malignant mass was given a grade (1, 2 or 3) on FNAC as per Robinson’s cytological grading system. Statistical correlation was made between colour Doppler findings and cytological results. Results: In our study we found colour Doppler characteristics of hypervascularity, tortuous arteries with irregular caliber, presence of a penetrating artery and a central pattern of distribution of vessels as signs significantly associated with malignancy. Mean RI of malignant masses was noted to be higher than benign masses, however no statistically significant correlation was observed between RI values and the grade of malignancy. Conclusion: Colour Doppler and power Doppler sonography are tools which provide useful information about the vascularity of a mass, hence these should be used routinely in the evaluation of all breast masses. Color Doppler does add vital supplementary information in the characterisation of breast masses on ultrasound, however in isolation, it is still limited in the specific differentiation of benign and malignant masses.

Keywords

• breast cancer
• hypervascularity
• neoangiogenesis
• penetrating vessel