The role of enhanced Doppler Ultrasound in differentiation of benign vs. malignant scar lesion after breast surgery for malignancy

Aim To evaluate the benefit of echo-contrast-enhanced Doppler sonography in the differentiation of benign vs. malignant breast lesions after surgical removal of a malignant breast mass. Methods Thirty-eight patients referred for biopsy of a palpable, suspicious scar lesion 1-15 years (mean 3.3 years) after surgery for breast cancer we re examined. During baseline ultrasound examination a subjective scoring sy stem of the vascularity, the number, the regularity of vessels' course and their Doppler parameters were assessed. After injection of an ultrasound co ntrast agent (Levovist(R)) the same scoring system was applied to the param eters together with enhancement Kinetics, enhancement intensity and enhance ment pattern. Any increase in the scoring level of two or more characterist ics (vascularity, number of vessels, intensify of enhancement in the tumor or regularity score of vessels in the lesion) was defined as suspicious for malignancy. A marked increase of enhancement in the immediate tumor periph ery was also regarded as suspicious for malignancy. The sonographic results were assessed prospectively and correlated with the histology of the lesio n. Results Of the 38 patients with a clinically-suspicious scar lesion, there were 28 true scars and 10 malignant scar lesions. All scar lesions showed n o or slight vascularity on baseline sonography. After Echocontrast-enhancem ent a significant increase in tumor vascularity and the number of tumor ves sels could be demonstrated in all 10 malignant lesions but in only one of t he 28 benign scars. Conclusion Scars pose inherent technical problems for optimal mammography. Sonographic evaluation of the vascularity of the lesion with contrast enhan cing agents showed improved diagnostic accuracy in the hands of an experien ced examiner.