Power Doppler Vocal Fremitus Breast Sonography: Differential Diagnosis with a New Classification Scheme—Power Doppler Vocal Fremitus Examination of Breast Lesions

Abstract

Purpose: In this study, unlike the previous studies, and Power Doppler vocal fremitus test (PDVFT) is utilized and is evaluated in subcategories to assess its role in the differentiation of benign and malignant lesions. Materials and Methods Thorough the 161 lesions of 147 patients are included in this prospective study. During PDVFT, it is determined that eight different fremitus patterns have broken out according to the colour aliasing during patient's vocal phonation. It is also grouped as, according to the lesion color aliasing pattern during vibration: (c) for central, (p) for peripheral, (d) for perilesional-desmoplastic, (e) for eccentric, (h) for heterogenous-hierarchic, (s) for septal, (t) for total, (z) for absent-zero. Thereafter, the patterns and histopathological results of the lesions are correlated and analysed statistically. Results Out of 161 lesions, (benign: 133 and malignant, 28 cases) totally 189 patterns are encountered. None of the patterns z, t, s or e was detected in any of the malignant lesions. Specific values for different patterns have been obtained which changing between 29% and 100%. After adding the PDVFT finding, the newly generated BIRADS scheme has the accuracy value as high 91%. Conclusion When it is classified according to the colour aliasing pattern(s) of lesion in PDVFT; the "p" pattern is seen about the same ratio in both malign lesion and benign lesion (nonspecific patterns); "c, d, h" patterns mostly related with malignancy, whereas "e, s, t, z" patterns related with benignity. With adding the PDVFT findings; accuracy of well known BIRADS categorization and lesion demarcation were also improved successfully.

Quantitative Ultrasound Elastography of Breast: A Review and Update with Emphasis on Shear Wave Imaging (ARFI)

“…For example, increasing the effectiveness of ultrasound with SCI reduces the degree of posterior acoustic shadowing [5]. Power doppler ultrasound with the vibration generated by the operator assist to some cases, but it still may not be very effective, especially in small lesions [6].…”