Female breast cancer seems to be responsible for the highest proportion of all female cancer deaths.
It is the most common female malignancy of midlife accounting for 31.3% of all cancers among Egyptian women in Cairo metropolitan area.
In recent years, our knowledge of breast cancer has progressed rapidly resulting in new approaches and techniques. The goal of the clinician is to differentiate between benign and malignant masses. Still nowadays the commonest investigation is mammography.
In the management of breast cancer, the contralateral breast should be examined by mammography, because about 3% of patients will have contralateral mammography detectable but clinically occult cancer. Also breast cancer now is considered a systemic disease.
Due to difficulties in interpretation of mammogram as in delineation of the lesion margin or the size of the tumor when arising in dense breast (specially the women age from 25-35 years) with hazards of ionizing radiation to these categories of young female. So additional modality as ultrasonography can play an important role in differentiating benign from malignant lesions. The position of the mass within the breast relative to the visible glandular tissue also approximate the size, allowing accurate portrayal of the constituent tissue of the breast and permit the detection of a variety of breast lesions specially in young females, pregnant and lactating patients or those with dense breast.
Since cancers usually show local hypervascularity, assessment of blood flow by Doppler ultrasound technique expected to have discriminatory value in diagnosis of breast lumps.
The study was performed on fifty female patients complaining of breast lumps with mean age (44.5 years).
Mammography was done and correlated with pathological diagnosis. Sensitivity of mammography in highly suspicious benign lesions were 65% and highly suspicious malignant lesions were 83.5% with total sensitivity 75%.
With combined both clinical examination and mammography, the sensitivity of benign cases raised up to 74% and malignant cases 85% with total sensitivity 80%.
The sensitivity of ultrasound found in highly suspicious benign 81% and highly suspicious malignant 76% with total sensitivity 785.
Vascularity of the breast masses (number of feeding vessels) examined with color flow Doppler results was: in benign proven cases with no vessels 28%, one to three vessels 9%, and more than vessel 20%, while in malignant proven cases with no blood flow was 27%, one to three vessels 50%, more than vessel 12.8%.
In benign lesions 24% revealing turbulent flow and 76% all types of flow when vascularity present. Malignant lesions revealed 76% turbulent flow while 33% all types of flow. So, all malignant tumors had vascularity with various types of signals and variable maximum flow velocities as well as benign tumors.
Flow was more significant in large benign lesions as giant fibroadenoma more than 5 cm.
The resistivity indices in benign tumors with flow was found of average value 0.85 but in malignant lesions its average value 0.92.
Pulsatility indices of benign lesions with flow had its mean value 1.95 and in malignant lesions mean value was 2.3. these indices not significantly differentiate between types of lesions.
Color Doppler sensitivity in highly suggestive benign lesions found 48% and in highly suggestive malignant lesions 69% with total sensitivity 60%.
When combined modalities of investigation such as ultrasound and color Doppler flow, the sensitivity was 85% in benign lesions and 84% in malignant lesions with total sensitivity of 84.6%.
We concluded from the previous study for Doppler ultrasonic flow revealed that malignant and benign masses had wide overlap measurements and not diagnostically useful alone as examination for breast lumps and not an absolute discrimination of malignancy, but the technique is a useful adjunct in the diagnostic assessment of breast tumors when accompanied with clinical examination, mammography and ultrasonography and a final tool is excision biopsy in highly suspicious malignant lesions by the previous combined techniques. |
