This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Özdemir, A. Articles by Çolak, M. Search for Related Content PubMed PubMed Citation Articles by Özdemir, A. Articles by Çolak, M.

Contrast-Enhanced Power Doppler Sonography in Breast Lesions

Effect on Differential Diagnosis After Mammography and Gray Scale Sonography

Ayegül Özdemir, MD, Koray Klç, MD, Hakan Özdemir, MD, Cem Yücel, MD, ebnem Andaç, MD and Meriç Çolak, MSc

Department of Radiology, University Hospital of Gazi, Ankara, Turkey (A.Ö., K.K., H.Ö., C.Y., .A.); and Department of Healthcare Management, Faculty of Health Sciences, University of Bakent, Ankara, Turkey (M.Ç.).

Address correspondence and reprint requests to Ayegül Özdemir, MD, Department of Radiology, University Hospital of Gazi, Besevler, Ankara 06510, Turkey. E-mail: aysozd{at}gazi.edu.tr.

Objective. To evaluate the efficacy of contrast-enhanced power Doppler sonography in the differential diagnosis of breast lesions after a mammography–gray scale sonography combination. Methods. Sixty-eight patients with 69 breast masses underwent power Doppler sonography before and after intravenous injection of a contrast agent. The lesions were diagnosed as "highly suggestive of malignancy" (category 5; n = 32), "suspicious" (category 4; n = 21), and "probably benign" (category 3; n = 16) by mammography and gray scale sonography, modeled on the American College of Radiology Breast Imaging Reporting and Data System classification. Power Doppler findings did not affect patient treatment. The authors subjectively evaluated the estimated area of vascularity, degree of enhancement following contrast agent administration, morphologic features, and distribution of vessels within the lesions. Results. The final diagnoses were malignant in 28 lesions and benign in 41. Significant enhancement after contrast agent injection was detected in both the malignant and benign groups. Only 2 criteria, estimated area of vascularity and degree of enhancement following contrast agent administration, proved to be significant diagnostic determinants for contrast-enhanced power Doppler sonography (P < .001; interobserver agreements, 74.4 and 77.8, respectively). Contrast-enhanced power Doppler sonography provided a higher specificity, positive predictive value, and negative predictive value than power Doppler sonography but a lower sensitivity and negative predictive value than mammography–gray scale sonography. Only in the category 4 lesions could the combination of mammography–gray scale sonography and contrast-enhanced power Doppler sonography accomplish a higher specificity (71%) and positive predictive value (70%) than mammography–gray scale sonography (39% and 53%, respectively). Conclusions. Power Doppler and contrast-enhanced power Doppler sonography cannot be recommended as confirmatory tests in Breast Imaging Reporting and Data System category 3 and category 5 lesions. Although contrast-enhanced power Doppler sonography may help reduce unnecessary biopsies in Breast Imaging Reporting and Data System category 4 lesions, recommendation of its use has many drawbacks, such as imperfectly established criteria, lack of absolute certainty, and high cost.

Key Words: breast neoplasms, diagnosis • breast neoplasms, sonography • sonography, contrast media • sonography, power Doppler studies

Abbreviations: BI-RADS, Breast Imaging Reporting and Data System • CE-PD, contrast-enhanced power Doppler sonography • DEFC, degree of enhancement following contrast agent administration • EAV, estimated area of vessels • FPR, false-positive ratio • MG, mammography • PD, power Doppler sonography • PPV, positive predictive value • NPV, negative predictive value

This article has been cited by other articles:

				F. Forsberg, C. W. Piccoli, D. A. Merton, J. J. Palazzo, and A. L. Hall Breast Lesions: Imaging with Contrast-enhanced Subharmonic US Initial Experience Radiology, September 1, 2007; 244(3): 718 - 726. [Abstract] [Full Text] [PDF]

				R. M. Kwee, M. A. A. J. van den Bosch, M. El Ouamari, B. Kemps, L. Arensman, R. van Hillegersberg, and W. P. Th. M. Mali Contrast-enhanced breast ultrasonography reveals an unusual breast tumor in a male patient with gynecomastia. J. Ultrasound Med., October 1, 2006; 25(10): 1347 - 1351. [Full Text] [PDF]