Objectives: To establish the usefulness of Resistive Index and vascularity patterns using Color Doppler Ultrasound (CDUS) in differentiating benign from malignant breast lesions and to correlate the imaging findings with pathologic results.

Results: Significantly increased values of  RI > 0.73, Peak systolic velocity >25cm/sec along with the presence of more penetrating vessels which are radially arranged and show chaotic vascularity are characteristic features of  malignant breast lesion. When RI is around 0.66- 0.73, Peak systolic velocity <25cm/sec along with the vascularity along the tumor margins in a peripheral net pattern, they are usually features of benign lesions. In this way we can differentiate benign from malignant breast pathologies and also categorise indeterminate lesions into either of them.

Conclusion: Color Doppler sonography is an ideal imaging technique that can be used in conjunction with basic imaging modalities such as mammography and grey scale imaging ultrasonography, as a non invasive method for confirmatory diagnosis of breast lesions. Some of the variables have been statistically analysed to establish its unique role in better evaluation of breast cancers. It’s based on the fact that most malignant lesions show more neovascularisation than benign lesions when compared to the normal breast parenchyma.

Keywords: Color Doppler sonography, Resistive Index (RI), Peak systolic velocity (PSV).

1. Stavros AT: Breast Ultrasound (1st Edition). Lippincott Williams & Wilkins, PA, USA (2004).
2. Wells PT, Halliwell M, Skidmore R, Webb AJ, Woodcock JP: Tumour detection by ultrasonic Doppler blood-flow signals. Ultrasonics 15, 231–232 (1977).
3. Minasian H, Bamber JC: A preliminary assessment of an ultrasonic Doppler method for the study of blood flow in human breast cancer. Ultrasound Med. Biol. 8, 357–364 (1982).
4. Giuseppeti GM, Baldassarre S, Marconi E: Color Doppler sonography. Eur. J. Radiol. 27, S254–S258 (1998).
5. Athanasiou A, Tardivon A, Ollivier L et al.: How to optimize breast ultrasound. Eur. J. Radiol. 69(1), 6–13 (2009).
6. Catalano O, Raso MM, D’Aiuto M et al.: Additional role of colour Doppler ultrasound imaging in intracystic breast tumours. Radiol. Med. 114(2), 253–266 (2009).
7. Cosgrove D, Kedar R, Bamber JC et al.: Breast diseases: color Doppler US in differential diagnosis. Radiology 189, 99–104 (1993). &One of the first works regarding the use of color Doppler in breast.
8. Sehgal C, Arger P, Rowling S et al.: Quantitative vascularity of breast masses by Doppler imaging: regional variations and diagnostic implications. J. Ultrasound Med. (19), 427–440 (2000).
9. Raza S, Baum J: Solid breast lesions: evaluation with power Doppler US. Radiology (203), 164 (1997). nn One of the first articles regarding the use of power Doppler in breast lesions.
10. 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. 20(10), 1091–1101 (2001).
11. Buadu L, Murakami J, Murayama S et al.: Colour Doppler sonography of breast masses: a multiparameter analysis. Clin. Radiol. 52(12), 917–923 (1997).
12. delCura JL, Elizagaray E, Zabala R et al.: The use of unenhanced Doppler sonography in the evaluation of solid breast lesions. Am. J. Roentgenol. 184(6), 1788–1794 (2005).
13. Kwak JY, Kim EK, Kim MJ et al.: Power Doppler sonography: evaluation of solid breast lesions and correlation with lymph node metastasis. Clin. Imaging 32(3), 167–171 (2008).
14. Yang WT, Tse GM, Lam PK et al.: Correlation between color power Doppler sonographic measurement of breast tumor vasculature and immunohistochemical analysis of microvessel density for the quantitation of angiogenesis. J. Ultrasound Med. 21(11), 1227–1235 (2002).
15. Du J, Li FH, Fang H et al.: Microvascular architecture of breast lesions: evaluation with contrast-enhanced ultrasonographic micro flow imaging. J. Ultrasound Med. 27(6), 833–842 (2008).

Dr Pearly Stephen

Post Graduate Student, Department of Radiodiagnosis, RMMCH, Annamalai University, Chidambaram - 608 002, Tamil Nadu, India