Color Doppler flow as an indicator of nodal metastasis in solid breast masses

Tumor metastases are dependent on angiogenesis. This prospective study evaluates the role of color Doppler sonographic signals in (1) detecting blood flow in solid breast masses, (2) differentiating between benign and malignant breast tumors, and (3) identifying women at risk for axillary lymph node metastasis. Ultrasonographically proved solid breast masses from 95 women were evaluated with color Doppler imaging for the presence of blood flow. A characteristic curvilinear or branching signal pattern, labeled the "rim sign," was noted to be either present or absent at the periphery of the mass in all cases. The color Doppler sonographic signals in 86 patients with pathologic results were correlated with the occurrence of malignancy and axillary lymph node metastasis. Fifty-three of the 86 patients (62%) had benign breast disease and 33 patients (38%) had malignant tumors. Sixteen (30%) of the benign tumors and 20 (61%) of the malignant cancers demonstrated a positive rim sign. A positive rim sign has a 61% sensitivity and a 70% specificity for the prediction of breast malignancy. In the malignant masses, nodal involvement occurred in 50% of patients with a positive rim sign and 10% of patients with a negative rim sign. A negative rim sign has a negative predictive value of 90% for nodal metastasis. Color Doppler imaging can detect blood flow in both malignant and benign solid breast masses. A positive rim sign is a poor prognostic factor whereas a negative rim sign is a good prognostic indicator for axillary nodal metastases.