Does Color Doppler Twinkling Change Between Ultrasound Platform Generations? - A Comparison Using Breast Biopsy...

Breast biopsy markers are used to mark biopsied tissues in the breast or axilla for potential future surgical excision. This study evaluated the color Doppler twinkling strength of 37 markers using two different ultrasound systems to assess if newer technology provides sufficient twinkling for clinical use.

Thirty-seven breast biopsy markers (36 commercially available and one polymethyl methacrylate (PMMA) research marker) were embedded in homogeneous gelatin phantoms and imaged using two ultrasound platforms (General Electric LOGIQ E9 and LOGIQ E10). Multiple linear and curvilinear transducers were evaluated. Two experienced breast radiologists independently scored twinkling strength in two separate sessions using an ordinal 0-4 scale, with scores ≥3 considered actionable twinkling. Statistical analyses included intra- and inter-observer reliability assessment, correlation analyses between twinkling scores and imaging parameters, and ordinal logistic regression modeling to evaluate system-, marker-, and transducer-level effects.

Of the 37 biopsy markers evaluated, 14 exhibited measurable twinkling and were included in statistical analyses. Several markers that demonstrated weak or non-actionable twinkling on the E9 achieved consistently higher and actionable scores on the E10. Model-based analysis showed substantial system-dependent differences by transducers, with the L8-18i demonstrating the largest improvement on the E10 (odds ratio (OR) 251.11 [95% CI: 67.52-933.88]; p < 0.001). The PMMA marker demonstrated consistently high and reproducible twinkling across both systems (mean scores: E9 = 3.4, E10 = 3.6).

Color Doppler twinkling by breast biopsy markers is strongly influenced by ultrasound system generation, transducer selection, and acquisition parameters.