B-mode color and color Doppler ultrasound imaging: Results of a prospective and comparative study with conventional gray-scale ultrasound analysis

Purpose: To evaluate possible advantages of B-mode color maps and color Doppler ultrasound in differential diagnosis of breast diseases. Material and methods: 3325 bilateral whole breast ultrasonic examinations were performed in 2250 consecutive women and 718 breast lesions were detected and studied using gray-scale, eight B-mode color maps and standard color Doppler. Color Doppler Energy was also used in 80 ultrasonic examinations and 46 lesions were thus studied. Fine-needle aspiration of 46 cysts and surgical excision of 59 benign and 65 malignant tumors were performed. Results: Ultrasonic diagnosis of breast diseases was easier by means of B-mode color maps than by gray-scale. Therefore, the use of pseudocolor display increased the efficiency of sonomammography. Blood vessels were detected only in 13% of benign mastopathies and in practically all cases of malignant tumors. Furthermore, the pattern of vascularization was different for each type of lesion and, specifically, vascular anarchy was characteristic of the cancers. Color Doppler Energy Imaging showed moderately increased vascularity and the morphology of vessels more accurately than Color Doppler Velocity Imaging. The simultaneous utilization of B-mode color and color Doppler ultrasound improved diagnostic accuracy of the sonomammography. Conclusion: The use of B-mode color maps does not change ultrasonic information, but significantly enhances our ability to study and evaluate the morphological structure of different tissues, compared to the gray-scale map alone. Furthermore, the simultaneous utilization of Color Doppler Velocity Imaging in routine examination of the breast lesions provides morphogical and vascular information that improve diagnostic accuracy, while the clinical benefit of Color Doppler Energy has yet to be demonstrated by more extensive studies.