Title: Evaluation of Doppler Spectral Indices As ‘Tests’ with High Sensitivity for the Provisional Diagnosis of Malignancy in Solid Breast Masses and the Recruitment of Cases for Confirmatory Tests
Authors: John N. J., Beenamol S., Ravikanth Balaji
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.95
Abstract
Introduction: The ‘cut off’ values of pulsatility index (PI) and resistive index (RI) described in the early literature on Doppler sonography of solid breast masses, for provisionally diagnosing malignancy had high specificity and relatively low sensitivity, the features of a ‘confirmatory test’. But the current role of ultrasonography and Doppler studies of solid breast masses is to recruit cases for confirmatory tests with high sensitivity for malignancy.
Aim of the work: To identify ‘cut off’ values of Doppler spectral indices that can be used as ‘tests’ to diagnose breast malignancy provisionally with high sensitivity, and thus can recruit cases for confirmatory tests.
Patients and Methods: The values of PI and RIof flow in arterioles within 49 solid breast lesions showing vascularity were compared with the final diagnosis. From receiver operating characteristic (ROC) curves the best cut off value with a very high sensitivity was identified for each Doppler spectral index.
Results: The value of PI equal to or greater than 1.1, as a test, has a sensitivity of 86.1%, specificity of 92.3%, and likelihood ratio (LR+) of 11.18, for a ‘provisional diagnosis’ of malignancy in solid breast mass. The value of RI equal to or greater than 0.66, as a test, has a sensitivity of 88.9%, specificity of 92.3%, and likelihood ratio (LR+) of 11.545.
Conclusions: Presence of arterioles with either PI≥1.1 or RI≥0.66 in a solid breast mass is indicative of malignancy with high sensitivity and can be used to recruit cases for confirmatory tests like FNAC and biopsy.
Keywords: Solid breast masses, Doppler ultrasound, Doppler spectral indices, pulsatility index, resistive index.
