DIAGNOSTIC ACCURACY OF SPECTRAL DOPPLER ULTRASOUND IN DETECTING SOLID BREAST LESION MALIGNANCY TAKING HISTOPATHOLOGY AS A GOLD STANDARD

Abstract

Background: Breast cancer remains the most prevalent malignancy among women globally and a major contributor to cancer-related mortality. In Pakistan, the burden of breast cancer continues to rise, with late-stage diagnosis being a common challenge. Early and accurate identification of malignancy in breast lesions is critical for improving outcomes. Spectral Doppler ultrasonography, a non-invasive modality, offers valuable insight into vascular patterns of breast masses and may enhance diagnostic accuracy when used alongside B-mode ultrasound.

Objective: To determine the diagnostic accuracy of spectral Doppler ultrasound in detecting malignancy in solid breast lesions, using histopathology as the gold standard.

Methods: This prospective observational study was conducted at the Radiology Department of Al-Razi Institute, Lahore. A total of 190 female patients aged 18–60 years, presenting with breast lesions categorized as BI-RADS III, IV, or V, were enrolled. After obtaining informed consent, each participant underwent spectral Doppler ultrasonography, followed by an ultrasound-guided core biopsy using an 18-gauge Trucut needle. Histopathological analysis was performed on formalin-preserved cores by a fellowship-trained consultant histopathologist. Diagnostic parameters, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy, were calculated by comparing Doppler findings with histopathology.

Results: Spectral Doppler ultrasonography identified malignancy in 86 cases (45.3%), while histopathology confirmed 90 cases (47.4%). The modality demonstrated 83.9% sensitivity, 95.5% specificity, 88.7% PPV, 93.4% NPV, and an overall diagnostic accuracy of 92.1%. Age-stratified and BI-RADS subgroup analyses further supported the high diagnostic value of Doppler imaging.

Conclusion: Spectral Doppler ultrasound is a reliable, accessible, and non-invasive diagnostic tool for differentiating benign from malignant solid breast lesions, offering high diagnostic accuracy when histopathology is unavailable or delayed.