Volume 7, Issue 4, December 2019, Page: 143-149
Role of Duplex Ultrasound for the Assessment of Malignancy in Breast Tumors
Anindita Rani Paul, Institute of Nuclear Medical Physics, Atomic Energy Research Establishment (AERE), Savar, Dhaka, Bangladesh
Faria Nasreen, National Institute of Nuclear Medicine & Allied Sciences, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
Nasreen Sultana, National Institute of Nuclear Medicine & Allied Sciences, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
Received: Sep. 15, 2019;       Accepted: Oct. 14, 2019;       Published: Oct. 23, 2019
DOI: 10.11648/j.crj.20190704.14      View  25      Downloads  22
Background: Breast cancer is the commonest form of cancer in females which may be curable if detected early. Breast ultrasound (US) is a non invasive, primary screening tool which can evaluate breast tumors in women even with dense breast. By adding color Doppler signal with B-mode US namely Duplex ultrasound better characterization of breast tumors is possible especially for the indeterminate tumors (BIRADS category 3 and 4) on B-Mode US. Objective: The purpose of this study is to assess the efficacy of Duplex Sonography (DS) for assessment of malignancy in breast tumors compared to histopathology. Materials and methods: This cross-sectional study was carried out at National Institute of Nuclear Medicine & Allied Science (NINMAS) from July 2017 to June 2018. A total of 57 female patients having breast tumors (age mean 42.09 years with SD ± 15.85) were included in this study. After clinical assessment, all study patients underwent Duplex Ultrasound and was then subjected to the excisional biopsy and histopathology for confirmation of the diagnosis. Diagnostic performance test of DS was done for diagnosis of breast malignancy compared to histopathology. Receiver-operator characteristic (ROC) curve was also constructed to determine the optimal cut-off point for each spectral Doppler indices. Results: On Color Doppler Sonography (CDS), hypervascularity was more common in malignant tumors than benign lesions (86.7%Vs 18.5%; p=0.001). Spectral Doppler indices including resistive index (RI) and pulsatility index (PI) were significantly higher in malignant tumors (p=0.001). All of these indices had high diagnostic accuracy for differentiating malignant from benign tumors with area under the curve (AUC) which is equals to 0.90, 0.92 for RI and PI respectively. The optimal cut-off points to differentiate benign and malignant tumors from ROC curve for RI was 0.75 (sensitivity: 89.0%, specificity: 85.0%) and that of PI was 1.2 (sensitivity: 96.6%, specificity: 80.0%). All obtained results of sensitivity, specificity and over all accuracy of DS (considering the vessel number on CDS & BIRADS criteria on B-mode US) were 93.3%, 81.5% and 87.7% respectively. Conversely, conventional B-Mode US alone had a sensitivity, specificity and over all accuracy of 100%, 55.6%, and 78.9% respectively. Addition of CDS to B-mode US in the same session increased specificity from 55.6% to 81.5% and accuracy from 78.9% to 87.7%. Conclusion: Duplex ultrasound has a significant role in the evaluation of breast tumors and adds value to B-mode US for distinguishing malignant tumors from benign lesions.
Breast Cancer, Ultrasound (US), Color Doppler Sonography (CDS), Duplex Sonography (DS), Resistive Index (RI), Pulsatility Index (PI)
To cite this article
Anindita Rani Paul, Faria Nasreen, Nasreen Sultana, Role of Duplex Ultrasound for the Assessment of Malignancy in Breast Tumors, Cancer Research Journal. Vol. 7, No. 4, 2019, pp. 143-149. doi: 10.11648/j.crj.20190704.14
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global Cancer Statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: ACancer Journal for Clinicians. Vol. 68, No. 6, 2018, pp. 394-424. DOI: 10.3322/caac.21492.
Kopans DB. The 2009 U.S. Preventive Services Task Force guidelines ignore important scientific evidence and should be revised or withdrawn. Radiology. Vol. 256, No. 1, 2010, pp. 15–20. DOI: 10.1148/radiol.10100057.
Sirous M, Sirous R, Nejad FK, Rabeie E, Mansouri M. Evaluation of different aspects of power Doppler sonography in differentiating and prognostication of breast masses. Journal of research in medical sciences. Vol. 20, No. 2, 2015, pp. 133-139.
Gupta K, Chandra T, Kumaresan M, Venkatesan B, Patil AB. Role of color Doppler for assessment of malignancy in solid breast masses: a prospective study. International Journal of Anatomy, Radiology and Surgery. Vol. 6, No. 1, 2017, pp. 59-65. DOI: 10.7860/IJARS/2017/24787:2246.
Stanzani D, Chala LF, Barros ND, Cerri GG, Chammas MC. Can Doppler or contrast-enhanced ultrasound analysis add diagnostically important information about the nature of breast lesions? Clinics (Sao Paulo). Vol. 69, No. 2, 2014, pp. 87-92. DOI: 10.6061/clinics/2014(02)03.
Horvath D, Cuitiño M, Pinochet M, Sanhueza P. Color Doppler in the study of the breast: How do we perform it? Revista Chilena de radiologia. Vol. 17, No. 1, 2011, pp. 19-27.
Lee SH, Chung J, Choi HY, Choi SH, Ryu EB, Ko KH et al. Evaluation of screening US–detected breast masses by combined use of elastography and color Doppler US with B-mode US in women with dense breasts: a multicenter prospective study. Radiology. Vol. 285, No. 2, 2017, pp. 660-669. DOI: 10.1148/radiol.2017162424
Cho N, Jang M, Lyou CY, Park JS, Choi HY, Moon WK. Distinguishing benign from malignant masses at breast US: combined US elastography and color Doppler US—influence on radiologist accuracy. Radiology. Vol. 262, No. 1, 2012, pp. 80-90. DOI: 10.1148/radiol.11110886.
Busilacchi P, Draghi F, Preda L, Ferranti C. Has color Doppler a role in the evaluation of mammary lesions? Journal of Ultrasound. Vol. 15, No. 2, 2012, pp. 93–98. DOI: 10.1016/j.jus.2012.02.007.
Zonderland H, Smithuis R. BI-RADS for mammography and ultrasound 2013 updated version. Radiology Assistant. 2014.
Davoudi Y, Borhani B, Rad MP, Matin N. The role of Doppler sonography in distinguishing malignant from benign breast lesions. Journal of Medical Ultrasound. Vol. 22, No. 2, 2014, pp. 92-95. DOI: 10.1016/j.jmu.2013.12.001.
Lee SW, Choi HY, Baek SY, Lim SM. Role of color and power Doppler imaging in differentiating between malignant and benign solid breast masses. Journal Clinical Ultrasound. Vol. 30, No. 8, 2002, pp. 459-64. DOI: 10.1002/jcu.10100.
Keshavarz E, Mehrjardi MZ, Karimi MA, Valian N, Kalantari M, Valian K. Diagnostic value of spectral Doppler ultrasound in detecting breast malignancies. International Journal of Cancer Management. Vol. 11, No. 2, 2018. DOI: 10.5812/ijcm.8200.
Zaini H. Role of color Doppler ultrasound versus histopathology in differentiating malignant from benign breast masses. Iraqi Academic Scientific Journal. Vol. 5, No. 2, 2006, pp. 155-159.
Li L, Zhou X, Zhao X, Hao S, Yao J, Zhong W, Zhi H. B-Mode ultrasound combined with color Doppler and strain elastography in the diagnosis of non-mass breast lesions: A prospective study. Ultrasoun in Medicine & Biology. Vol. 43, No. 11, 2017, pp. 2582-2590. DOI: 10.1016/j.ultrasmedbio.2017.07.014.
Choi JS, Han BK, Ko EY, Ko ES, Shin JH, Kim GR. Additional diagnostic value of shear-wave elastography and color Doppler US for evaluation of breast non-mass lesions detected at B-mode US. Eur Radiol. Vol. 26, No. 10, 2016, pp. 3542–3549. DOI: 10.1007/s00330-015-4201-6.
Browse journals by subject