Evaluation of diagnostic value of Doppler ultrasound in the diagnosis of malignant breast masses

Submitted: 9 February 2024
Accepted: 25 February 2024
Published: 26 March 2024
Abstract Views: 908
PDF: 58
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


  • Bahareh Mehdikhani Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran, Islamic Republic of.
  • Milad Benam Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran, Islamic Republic of.
  • Afrooz Moradkhani Dezful University of Medical Sciences, Dezful, Iran, Islamic Republic of.
  • Ayda Roostaee Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran, Islamic Republic of.
  • Seyedeh Sabahat Bahman Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran, Islamic Republic of.
  • Pooyan Barmayoon Department of Radiology, Firoozgar Clinical Research Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
  • Ghazaleh Dezyani Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran, Islamic Republic of.
  • Zeinab Safarpour Lima Department of Radiology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran, Islamic Republic of.

Breast cancer is the leading cause of cancer mortality in women, and it is on the rise in Iran. Therefore, an early-stage diagnosis of breast cancer is of critical importance. Because ultrasound is one of the available, inexpensive, and minimally invasive techniques for distinguishing malignant from benign masses, a comparison of conventional ultrasound, color Doppler, and spectral Doppler findings can be useful. The purpose of this study was to determine the diagnostic value of sonographic indices, specifically Doppler parameters, in identifying the nature of breast masses. This is a cross-sectional study, with diagnostic value analysis. Before undergoing a biopsy, 80 patients with breast masses underwent B-mode and Doppler breast ultrasound. The ultrasound findings were then compared to pathologic results to determine which groups were malignant or benign. The resulting data were analyzed using statistical tests and diagnostic values with SPSS 22 software. B-mode grey-scale ultrasound indices such as mass shape, mass margin, mass orientation, and posterior features, as well as Doppler indices such as vascularity, RI (Resistive Index), PI (Pulsatility Index), and PSV (Peak Systolic Velocity), were found to be statistically significant with pathological findings. Color Doppler revealed vascularity in 65% of benign and 84% of malignant masses. The diagnostic value results revealed that mass shape, mass margin, mass orientation, and posterior features all play a significant role in predicting lesion malignancy, with a sensitivity of 92%, 58%, 64%, 56%, and specificity of 59%, 66%, 82%, and 84%, respectively. The RI, PI, and PSV indices were significantly higher in malignant masses, and all of them had remarkable diagnostic values in predicting malignancy, with a (Area Under The Curve) AUC of 0.863, 0.882, 0.702, a sensitivity of 84% and 84%, 68%, and a specificity of 83%, 86%, and 62%, respectively, at the optimal cut-off points (0.65, 1.32, 12.40) obtained from the Receiver Operating Characteristics (ROC) curves.

Wolman I. Berek and Novak’s Gynecology 15th Edition: Lippincott Williams and Wilkins, 2012.

Wagner HN, Szabo Z, Buchanan JW. Principles of nuclear medicine. Pennsylvania: W.B. Saunders, 1995, p 235.

Yavari P, Mosavizadeh M, Sadrol-Hefazi B, Mehrabi Y. Reproductive characteristics and the risk of breast cancer--a case-control study in Iran. Asian Pac J Cancer Prev 2005;6:370-5.

Sandler MP, Patton JA, Gottschalk A. Diagnostic nuclear medicine. Pennsylvania: Williams & Wilkins, 1996.

Ozdemir A, Ozdemir H, Maral I, et al. Differential diagnosis of solid breast lesions: contribution of Doppler studies to mammography and gray scale imaging. J. Ultrasound Med 2001;20:1091–101. DOI: https://doi.org/10.7863/jum.2001.20.10.1091

Hashmi A, Ackerman S, Irshad A. Color Doppler sonography: characterizing breast lesions. Imaging Med 2010;2:151–63. DOI: https://doi.org/10.2217/iim.10.10

William EB. Fundamental of Diagnostic Radiology.4th ed. Philadelphia: Williams & Wilkins, 2012; pp 535-7.

Rumack CM, Wilson SR, Charboneau JW. Diagnostic ultrasound. 3th ed Philadelphia, 2011; pp 773-86.

Svensson WE, Pandian AJ, Hashimoto H. The use of breast ultrasound color Doppler vascular pattern morphology improves diagnostic sensitivity with minimal change in specificity. Ultraschall Med 2010;31:466–74. DOI: https://doi.org/10.1055/s-0028-1109478

Keshavarz E, Zare Mehrjardi M, Karimi M A, et al. Diagnostic value of spectral doppler ultrasound in detecting breast malignancies: an original article. Int J Cancer Manag 2018;11:e8200. DOI: https://doi.org/10.5812/ijcm.8200

Shobeiri E, Panahi F. Comparison of the diagnostic value of the gray scale and color Doppler ultrasonography in the diagnosis of solid breast masses. SJKU 2014;19:77-83.

Bassett LW, Ysrael M, Gold RH, Ysrael C. Usefulness of mammography and sonography in women less than 35 years of age. Radiology 1991;180:831-5. DOI: https://doi.org/10.1148/radiology.180.3.1871302

Buadu L, Murakami J, Murayama S, et al. Colour Doppler sonography of breast masses: a multiparameter analysis. Clin. Radiol 1997;52:917–23. DOI: https://doi.org/10.1016/S0009-9260(97)80224-3

McNicholas MM, Mercer PM, Miller JC, et al. Color Doppler sonography in the evaluation of palpable breast masses. AJR Am J Roentgenol 1993;161:765-71. DOI: https://doi.org/10.2214/ajr.161.4.8372754

Del Cura JL, Elizagaray E, Zabala R, et al. The use of unenhanced Doppler sonography in the evaluation of solid breast lesions. Am J Roentgenol 2005;184:1788–94. DOI: https://doi.org/10.2214/ajr.184.6.01841788

AhmadiNejad P, Shahriaran S, GhasemiPhiroozabadi A, Giti M. Evaluation of solid breast lesions with color doppler sonography and power doppler imaging. Tehran University Medical Journal 2002;60:277-82.

Busilacchi P, Draghi F, Preda L, Ferranti C. Has color Doppler a role in the evaluation of mammary lesions? J Ultrasound 2012;15:93–8. DOI: https://doi.org/10.1016/j.jus.2012.02.007

Kwak JY, Kim EK, Kim MJ, et al. Power Doppler sonography: evaluation of solid breast lesions and correlation with lymph node metastasis. Clin Imaging 2008;32:167–71. DOI: https://doi.org/10.1016/j.clinimag.2007.12.004

Ibrahim R, Rahmat K, Fadzli F, et al. Evaluation of solid breast lesions with power Doppler: value of penetrating vessels as a predictor of malignancy. Singapore Med J 2016;57:634-40. DOI: https://doi.org/10.11622/smedj.2016001

Raza S, Baum J. Solid breast lesions: evaluation with power Doppler US. Radiology 1997;203:164. DOI: https://doi.org/10.1148/radiology.203.1.9122386

Davoudi Y, Borhani B, Rad M, Matin M. The role of Doppler sonography in distinguishing malignant from benign breast lesions. J Med Ultrasound 2014;22:92-5. DOI: https://doi.org/10.1016/j.jmu.2013.12.001

Sarkar SS. To determine role of colour doppler ultrasound in breast lesions. J Adv Med Dent Scie Res 2020;8:203-6.

Mesaki K, Hisa N, Kubota K, et al. Differentiation of benign and malignant breast tumors using Doppler spectral parameters including acceleration time index. Oncol Rep 2003;10:945-50. DOI: https://doi.org/10.3892/or.10.4.945

Lee WJ, Chu JS, Houng SJ, et al. Breast cancer angiogenesis: a quantitative morphologic and Doppler imaging study. Ann Surg Oncol 1995;2:246–51. DOI: https://doi.org/10.1007/BF02307031

Stanzani D, Chala LF, Barros N, et al. Can Doppler or contrast-enhanced ultrasound analysis add diagnostically important information about the nature of breast lesions? Clinics (Sao Paulo) 2014;69:87–92. DOI: https://doi.org/10.6061/clinics/2014(02)03

Fu X, Lu K, Zhang J, et al. Significance of resistance index and pulsatility index in differential diagnosis of breast neoplasm. Zhongguo Yi XueKeXue Yuan XueBao 1998;20:454-8.

Choi HY, Kim HY, Baek SY, et al. Significance of resistive index in color Doppler ultrasonogram: differentiation between benign and malignant breast masses. Clin Imaging 1999;23:284-8. DOI: https://doi.org/10.1016/S0899-7071(99)00152-7

Parveen I, Javed K, Elahi B, et al. Evaluation of breast lesions with Doppler ultrasound: Diagnostic accuracy of resistive index as a predictor of malignancy. Professional Med J 2020;27:825-30. DOI: https://doi.org/10.29309/TPMJ/2020.27.04.3947

Schmillevitch J, Guimara˜es Filho He´lio A, De Nicola H, et al. Utilization of vascular resistance index in the differentiation between benign and malignant breast nodules. Radiol Bras 2009;42:241e4. DOI: https://doi.org/10.1590/S0100-39842009000400010

Mehdikhani, B., Benam, M., Moradkhani, A., Roostaee, A., Bahman, S. S., Barmayoon, P., Dezyani, G., & Safarpour Lima, Z. (2024). Evaluation of diagnostic value of Doppler ultrasound in the diagnosis of malignant breast masses . European Journal of Translational Myology. https://doi.org/10.4081/ejtm.2024.12372


Download data is not yet available.