Tozaki Mitsuhiro, Fukuma Eisuke
Division of Breast Imaging, Breast Center, Kameda Medical Center, Kamogawa, Chiba, Japan.
Acta Radiol. 2011 Sep 1;52(7):706-10. doi: 10.1258/ar.2011.110039. Epub 2011 May 19.
Power Doppler ultrasonography (US) is used in addition to B-mode US as a tool for the differential diagnosis between benign and malignant lesions. However, there are few data showing how useful power Doppler US is for BI-RADS category assessment.
To assess how much power Doppler US contributed to increasing the category diagnosis from Breast Imaging Reporting and Data System (ACR BI-RADS(®)-US) category 3 to category 4.
A total of 2426 patients (age range 16-91 years, mean 52 years) who underwent B-mode and power Doppler breast US using a linear 10-MHz transducer were analyzed. We devised integrated US category classification (BI-RADS-Integral) based on BI-RADS descriptors and vascularity. Masses with a circumscribed margin, parallel orientation, and negative vascularity on power Doppler US were defined as category 3. Irregular-shaped masses with a spiculated margin or echogenic halo were defined as category 5. Masses with one of the four suspicious findings (no circumscribed margin, no parallel orientation, microcalcifications, and positive vascularity) were defined as category 4a, and masses with two or more suspicious findings were defined as category 4b.
There were 98 breast cancer cases, and the average sizes of invasive and non-invasive cancers were 15 mm and 18 mm, respectively. The frequency of breast cancer according to category was: 0.4% (3/714) of the category 3 cases, 2.7% (7/256) in category 4a, 64% (47/73) in category 4b, and 100% (41/41) in category 5. Among the cases with a category 4a mass lesion, there were 183 lesions whose category diagnosis had been raised from category 3 to category 4a based on the Doppler blood flow findings alone, and 3 (1.6%) of those lesions were breast cancer. All three of them were ductal carcinoma in situ (DCIS) cases. When the cut-off point was placed between category 3 and category 4, BI-RADS-Integral and BI-RADS-US without power Doppler had a sensitivity of 96.9% and 93.9%, respectively, specificity of 72.1% and 90.4%, respectively, and accuracy of 74.4% and 90.7%, respectively.
The presence of Doppler blood flow increases the malignancy pick-up rate, but at the expense of a significant decrease in specificity and diagnostic accuracy and an increase in biopsy rate.
除B型超声外，能量多普勒超声（US）被用作鉴别良性和恶性病变的工具。然而，很少有数据表明能量多普勒超声在乳腺影像报告和数据系统（ACR BI-RADS（®）-US）分类评估中有多大作用。
评估能量多普勒超声在将乳腺影像报告和数据系统（ACR BI-RADS（®）-US）3类诊断提升至4类诊断中所起的作用。
分析了总共2426例患者（年龄范围16 - 91岁，平均52岁），这些患者使用线性10MHz探头接受了B型和能量多普勒乳腺超声检查。我们基于BI-RADS描述符和血管情况设计了综合超声分类（BI-RADS-Integral）。能量多普勒超声显示边缘清晰、平行方位且无血管的肿块定义为3类。边缘呈毛刺状或有回声晕的不规则形肿块定义为5类。具有四项可疑特征之一（边缘不清晰、非平行方位、微钙化和血管阳性）的肿块定义为4a类，具有两项或更多可疑特征的肿块定义为4b类。
共有98例乳腺癌病例，浸润性癌和非浸润性癌的平均大小分别为15mm和18mm。各类别乳腺癌的发生率分别为：3类病例中的0.4%（3/714），4a类中的2.7%（7/256），4b类中的64%（47/73），5类中的100%（41/41）。在4a类肿块病变病例中，有183个病变仅基于多普勒血流表现其分类诊断从3类提升至4a类，其中3个（1.6%）病变为乳腺癌。这3个均为导管原位癌（DCIS）病例。当截断点设定在3类和4类之间时，BI-RADS-Integral和不使用能量多普勒的BI-RADS-US的敏感性分别为96.9%和93.9%，特异性分别为72.1%和90.4%，准确性分别为74.4%和90.7%。
多普勒血流的存在提高了恶性肿瘤的检出率，但代价是特异性和诊断准确性显著降低以及活检率增加。
