Diagnosing breast lesions with contrast-enhanced 3-dimensional power Doppler imaging.
OBJECTIVE
To compare mammography with contrast-enhanced 2- and 3-dimensional power Doppler imaging for the diagnosis of breast cancer.


METHODS
Fifty-five patients, who underwent breast biopsies with histopathologic assessment, participated in a study of mammography and contrast-enhanced sonography. Levovist (Berlex Laboratories, Montville, NJ) and Optison (Mallinckrodt, St Louis, MO) were administrated to 22 and 33 patients, respectively. Precontrast and postcontrast 2-dimensional power Doppler data of the lesion were obtained with an HDI 3000 system (Philips Medical Systems, Bothell, WA), and 3-dimensional data were acquired with an LIS 6000A system (Life Imaging Systems Inc, London, Ontario, Canada). Two independent and blinded readers assessed diagnosis. Receiver operating characteristic curves were computed individually and in combination for mammography and 2- and 3-dimensional sonography (before and after contrast). Histopathologic and imaging parameters were compared by Mann-Whitney statistics.


RESULTS
Mammographic findings were available for 50 patients, biopsy for 54, and 2- and 3-dimensional sonographic images for 53 and 52, respectively. Of the 50 patients who had all 4 measures, 15 (30%) had malignancies. The areas under the receiver operating characteristic curve for the diagnosis of breast cancer were 0.51 for 2-dimensional contrast-enhanced imaging, 0.60 for 3-dimensional power Doppler imaging, and 0.76 for 3-dimensional contrast-enhanced imaging (P < .01). Mammography produced an area of 0.86, which increased when combined with 3-dimensional contrast-enhanced imaging to 0.90 and with all sonographic modalities to 0.96 (P < .001). The histopathologic diagnosis of benign or malignant correlated with the presence or absence of anastomoses and with the degree of vascularity assessed with contrast-enhanced 3-dimensional power Doppler imaging (P = .007 and .02).


CONCLUSIONS
Contrast-enhanced 3-dimensional power Doppler imaging increases the ability to diagnose breast cancer relative to conventional 2- and 3-dimensional sonographic imaging.
Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. flemming.forsberg@jefferson.edu
Flemming
F
Forsberg
Barry B
BB
Goldberg
Christopher R B
CR
Merritt
Laurence
L
Parker
Andrea J
AJ
Maitino
Juan J
JJ
Palazzo
Daniel A
DA
Merton
Susan M
SM
Schultz
Laurence
L
Needleman
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016015:Logistic Models; D008327:Mammography; D008875:Middle Aged; D011134:Polysaccharides; D012372:ROC Curve; D018709:Statistics, Nonparametric; D018608:Ultrasonography, Doppler; D016217:Ultrasonography, Mammary
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508