Differential diagnosis of solid breast lesions - Contribution of Doppler studies to mammography and gray scale imaging

Objective. To assess the role of Doppler sonography when used in conjunctio n with mammography and gray scale sonography in differentiating solid breas t lesions and to find out whether lesion size is a limiting factor for Dopp ler evaluation. Methods. One hundred twelve lesions 70 malignant and 42 ben ign) detected with mammography and sonography were prospectively examined w ith color, power, and pulsed Doppler sonography. Vascularity was analyzed m orphologically (vessel location, form, and color tone) and semiquantitative ly (by spectral indices) to determine the valuable diagnostic flow characte ristics. The lesions were classified by 2 observers as benign or malignant on the basis of each diagnostic technique (namely, 8 combination of mammogr aphy and gray scale sonography, presence or absence of blood flow, morpholo gic flow analysis, and spectral flow analysis). The results were compared w ith the histologic diagnosis in 105 lesions and with the clinical and radio logic diagnosis after at least 2 years of follow-up in 7 lesions. Results T he sensitivity and specificity of the mammography-gray scale sonography com bination were 98.6% and 76.2%, respectively. Neither morphologic nor spectr al Doppler analysis proved to be successful on its own; however information obtained from investigated morphologic and spectral flow features increase d the specificity of mammography and gray scale sonography for lesions 10 m m and smaller (from 88.9% to 100%) and those larger than 10 mm (from 70% to 96.6%). Conclusions. Our data show that Doppler sonography is a beneficial adjunct to mammography and gray scale sonography for solid breast lesions 10 mm and smaller and those larger than 10. mm.