The use of color-coded sonography in evaluating suspicious breast masses

Aim The relationship between tumour vessel density and tumour vitality in breast carcinoma has been well established in histopathological studies. Our objective was to find out if colour-coded sonography is helpful in the evaluation of suspicious breast masses. Method 106 patients were studied; in all cases a biopsy was obtained. Peripheral and central blood vessels in a lesion were counted and peak systolic velocities (PSV) were measured as well as the resistive index (RI). The grade of vascularisation was scored on a scale from I-IV indicating an increasing vessel count and increasing PSV. Results 83% of the carcinoma (n=61) and 45% of the benign lesions (n=45) showed vascularity grade III or IV (hypervascularity). The mean PSV of all carcinomas was 0.23 mis, in benign lesions 0.14 m/s (p < 0.005). Although G3 carcinomas showed higher vascularisation than G2 carcinomas, the difference was not statisticaly significant. T3 + 4 tumours had significantly higher PSV than T1 + 2 carcinomas (p < 0.01). In 12 of 23 cases with unclear morphology in the B-mode, the additional finding of hypervascularity led to the misinterpretation of a benign lesion as a carcinoma. Conclusion Although increased vascularity correlated with degree of malignancy the finding of hypervascularity did not help to distinguish a benign from a malignant lesion in individual cases. Consequently, it did not help to reduce the biopsy rate. In benign lesions with hypervascularity and borderline morphology, the risk of a false positive diagnosis is high.