[Evaluating the morphology of uncertain breast tumors using color coded Doppler ultrasound]

The relationship between tumour vessel density and tumour vitality in breast carcinoma has been well established in histopathological studies. Our objective was to find out if colour-coded sonography is helpful in the evaluation of suspicious breast masses.

106 patients were studied; in all cases a biopsy was obtained. Peripheral and central blood vessels in a lesion were counted and peak systolic velocities (PSV) were measured as well as the resistive index (RI). The grade of vascularisation was scored on a scale from I-IV indicating an increasing vessel count and increasing PSV.

83% of the carcinoma (n = 61) and 45% of the benign lesions (n = 45) showed vascularity grade III or IV (hypervascularity). The mean PSV of all carcinomas was 0.23 m/s, in benign lesions 0.14 m/s (p < 0.005). Although G3 carcinomas showed higher vascularisation than G2 carcinomas, the difference was not statistically significant. T3 + 4 tumours had significantly higher PSV than T1 + 2 carcinomas (p < 0.01). In 12 of 23 cases with unclear morphology in the B-mode, the additional finding of hypervascularity led to the misinterpretation of a benign lesion as a carcinoma.

Although increased vascularity correlated with degree of malignancy the finding of hypervascularity did not help to distinguish a benign from a malignant lesion in individual cases. Consequently, it did not help to reduce the biopsy rate. In benign lesions with hypervascularity and borderline morphology, the risk of a false positive diagnosis is high.