COLOR DOPPLER SONOGRAPHY IN THE EVALUATION OF PALPABLE BREAST MASSES

OBJECTIVE. A prospective study was performed to determine the value of high-resolution color Doppler sonography in the evaluation of palpable solid breast masses. SUBJECTS AND METHODS. One hundred thirty-one consecutive breast lesions were characterized as benign, malignant, or indeterminate on the basis of their sonographic appearance. The number of blood vessels was estimated, the Doppler spectrum for each vessel was characterized, and the maximum velocity was recorded. Mammography was performed in most cases. Histology was obtained in all cases. RESULTS. Predictions based on sonography alone were correct in 74% of benign lesions and 63% of malignant lesions (p < .001). Blood flow was demonstrated in 87% of malignant lesions and in 68% of benign lesions (p = .0105). Malignant lesions were larger than benign lesions (p = .004) and showed a significantly greater number of vessels (p < .001) and significantly higher maximum velocity (mean, 34.2 vs 19.2 cm/sec; p < .001). Patients with malignant lesions were significantly older (p < .001). When age, size of lesion, and sonographic morphology were controlled, the presence of blood flow did not aid in diagnosis. However, in lesions with blood flow, when spectral patterns and maximum velocity were analyzed, a logistic model combining these parameters with age, size, and sonographic morphology gave an overall sensitivity of 94%, specificity of 93%, and positive predictive value of 92%. Mammography yielded useful additional information, particularly for indeterminate lesions. CONCLUSION. Maximum velocity and spectral patterns on Doppler analysis are useful indicators of breast malignancy, but only if the patient's age, the size of the lesion, and the sonographic morphology are also considered. The best use of color flow imaging is in combination with mammography.