title: The use of unenhanced Doppler sonography in the evaluation of solid breast lesions.
abstract: OBJECTIVE
  The objectives of our study were to investigate differences in Doppler sonography features between benign and malignant breast lesions and between malignant lesions with different prognostic factors and to propose diagnostic criteria for Doppler sonography of breast lesions.
  
  
  METHODS
  We performed power and duplex Doppler sonography examinations in 826 breast lesions scheduled for sonographically guided core needle biopsy. Lesion vascularity, pulsatility index (PI), and resistive index (RI) of the vessels detected were analyzed and correlated with histologic results.
  
  
  RESULTS
  Color flow was more frequently seen in malignant (237/348 lesions, 68%) than in benign (171/478, 36%) lesions (p < 0.001). However, sensitivity, specificity, and positive and negative predictive values for this sign were low (68%, 64%, 58%, and 73%, respectively). The RI and PI values were significantly higher (p < 0.001) in cancers. Although an overlap in these values between benign and malignant lesions was observed, all but one nodule with an RI of greater than 0.99 (those with null or inverted diastolic flow) or a PI of greater than 4 were malignant. No significant relationship was found between PI, RI, or flow visualization on power Doppler sonography and tumor grade or lymph node involvement in cancers.
  
  
  CONCLUSIONS
  Flow visualization on power Doppler sonography indicates a higher possibility of malignancy but is not useful as the main sign for malignancy. However, any lesion with a vessel that has an RI value greater than 0.99 or a PI value greater than 4 within it must be considered as probably malignant regardless of any other sonography sign present. Doppler findings are not useful to predict tumor grade or lymph node involvement.
authors.affiliation: Servicio de Radiodiagnóstico, Hospital de Basurto, Av. Montevideo 18, Bilbao 48014, Spain. jdelcura@hbas.osakidetza.net
authors.forename: Jose L
authors.initials: JL
authors.lastname: del Cura
authors.forename: Elena
authors.initials: E
authors.lastname: Elizagaray
authors.forename: Rosa
authors.initials: R
authors.lastname: Zabala
authors.forename: Ana
authors.initials: A
authors.lastname: Legórburu
authors.forename: Domingo
authors.initials: D
authors.lastname: Grande
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D001940:Breast / Q000098:blood supply / Q000473:pathology; D001943:Breast Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler; D016217:Ultrasonography, Mammary