Neovascularity patterns in breast carcinoma: correlation of Doppler ultrasound features with sonographic tumour morphology.

OBJECTIVE To determine the association and correlation between morphologic features of breast cancer on gray scale ultrasound, and vascularity patterns and indices on color and spectral Doppler ultrasound. STUDY DESIGN Cross-sectional, analytical study. PLACE AND DURATION OF STUDY Department of Radiology, Dow University of Health Sciences and Civil Hospital, Karachi, from August 2006 to June 2007. METHODOLOGY Fifty adult female patients with histopathological proven breast cancer underwent ultrasound for evaluation of morphologic features on gray scale mode; vascularity patterns on color Doppler scan and flow indices measurement on spectral Doppler ultrasound. Regression analysis was conducted to determine correlation between the variables and associations of vascularity patterns. RESULTS The 50 studied patients had predominantly solid tumour in 46 (92%) with depth to width ratio of > 1 in 37 (76%). The mean tumour size was 3.6 +/- 1.34 cm, with irregular margins in 41 (82%), posterior shadowing in 43 (86%) and calcifications in 27 (54%). Type 3 vascularity (multiple peripheral vessels) was the most frequent pattern (n=21, 42%) that showed a positive correlation with solid tumours (r=0.7, p < 0.001). Low resistance spectral waveform was seen in 44 (88%) cases. The average size was 3.69 cm in vascular and 3.1 cm in avascular tumours. Mean resistive index (RI) was 0.67. Mean pulsatility index (PI) was 1.1. RI was significantly high in cystic tumours (mean=0.8, p < 0.001) and significantly low in tumours measuring less than 2 cm (RI=0.18, p < 0.001). CONCLUSION In this study, multiple peripheral vessels with low resistance flow was the pattern most significantly associated with all appearance of focal breast cancer. Apart from a positive correlation with solid tumours, markedly high RI in cystic tumours and markedly low RI in tumours less than 2 cm, there was no consistent correlation trend difference between Doppler findings and tumour size. Histopathology, therefore, remains the main modality to evaluate the tumour type and characteristics.