title: Multivariate analysis of flow data in breast lesions and validation in a normal clinical setting.
abstract: OBJECTIVE
  To improve differentiation between benign and malignant breast lesions by Doppler measurements and to validate results in a normal clinical setting in comparison to study conditions.
  
  
  METHODS
  Doppler measurements of 458 patients were compared in benign and malignant tumors in a prospective study. In a multivariate analysis a diagnostic score was developed using a logistic regression model and stepwise selection. These results were compared with 272 patients who were examined under routine clinical conditions.
  
  
  RESULTS
  Most measurements showed highly significant (p < 0.001) differences between benign and malignant tumors. For each measurement we considered two cut-points to define a diagnostic rule. Despite significant differences, none of the corresponding classification rules exceeded 90 % sensitivity and specificity. Multivariate analysis selected a model including age and the number of arteries and contralateral arteries. Although significant, the last factor barely improved diagnostic accuracy. Therefore, we deleted it from the multivariate model. Based on a simple model including age and the number of tumor arteries, we defined classification rules with high sensitivity and specificity. The RI measurement did not improve the discriminatory power of our score. In the validation study the sensitivity decreased from 89 - 98 % to 58 - 78 % with a specificity of 82 - 92 % vs. 83 - 86 %.
  
  
  CONCLUSIONS
  Color Doppler can be used for breast cancer differentiation. However, in the clinical routine the sensitivity decreases considerably compared with optimized study conditions.
authors.affiliation: Gynecology, DKD, Wiesbaden. madjar.gyn@dkd-wiesbaden.de
authors.forename: H
authors.initials: H
authors.lastname: Madjar
authors.forename: W
authors.initials: W
authors.lastname: Sauerbrei
authors.forename: L
authors.initials: L
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001943:Breast Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging*; D018270:Carcinoma, Ductal, Breast / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000098:blood supply* / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*; D016217:Ultrasonography, Mammary / Q000379:methods*