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3-D Doppler May Unmask Malignant Breast Lesions 10-21-08
Noninvasive distinctions between malignant and benign breast lesions emerged
more clearly when evaluated by 3-D Doppler ultrasound, investigators here
concluded.
In a group of women with suspicious breast lesions, 3-D power Doppler assessment
of lesion vascularity had a 100% sensitivity and 86% specificity, Gerald L.
LeCarpentier, Ph.D., of the University of Michigan, and colleagues reported in
the November issue of Radiology.
If the results are borne out in larger studies, the imaging technique has the
potential to spare some women from biopsies.
"Using speed-weighted 3-D power Doppler ultrasound, higher flow velocities in
the malignant tumor-feeding vessels may be detected, whereas vessels with slower
flow velocities in surrounding benign masses may be excluded," said Dr.
LeCarpentier.
Despite extensive investigation, debate has surrounded Doppler's ability to
reflect microvasculature and differentiate between malignant and benign breast
lesions, the authors said.
Authorities generally agree that Doppler measures reflect overall vascularity,
they continued. Additionally, some studies have suggested that flow velocities
correlate with tumor size and that parameters such as vessel count and flow
velocity can be used to identify malignant lesions.
However, previous studies generally have used two-dimensional rather than
three-dimensional images to assess vascular morphology, density, and velocity
distributions. Previously, Dr. LeCarpentier and colleagues found that
speed-weighted pixel density derived from 3D Doppler images had accuracy similar
to that of grayscale evaluation for distinguishing malignant from benign breast
lesions.
More recently, the investigators found that evaluation of breast lesions with a
handheld 3-D technique that incorporated multiple indices (including
speed-weighted pixel density and gray scale) provided superior discrimination.
They continued that investigation in the current study.
Speed-weighted 3-D Doppler flow measurement was combined with patient age and
ultrasound gray scale information in the evaluation of 78 patients scheduled for
breast biopsy for diagnosis of palpable or nonpalpable lesions. The study
population included 38 patients from earlier research and an additional 40
patients for confirmation.
For each patient, a series of color Doppler images was acquired and
reconstructed into a 3-D volume that encompassed the suspicious mass. By
combining data from all 78 cases (46 benign and 32 malignant), the authors found
that the area under the receiver operating characteristic curve (Az) confirmed
previous research showing that speed-weighted pixel density performed best as a
diagnostic index (P=0.01).
In the initial 38 patients and in the 40-patient confirmatory evaluation, the
three-variable index of speed-weighted pixel density, age, and grayscale
performed significantly better than any single variable (Az=0.97).
Setting the three-variable index to its maximum value resulted in a sensitivity
of 100% and specificity of 86% in the 40-patient evaluation. The authors found
that the performance was similar in both the 38-patient learning set and the
test set.
"The enhanced diagnostic performance of three-dimensional Doppler-based
multivariable indexes over grayscale [ultrasound] evaluation alone may
eventually lead to the elimination of some biopsies," the authors concluded.
The authors noted that a limitation of the study was that the use of only one
reader to draw the areas of interest may have introduced a bias.