Power Doppler Vocal Fremitus Breast Sonography: Differential Diagnosis with a New Classification Scheme—Power Doppler Vocal Fremitus Examination of Breast Lesions
Duzgun Yildirim, Bengi Gurses, Baki Ekci, Ahmet Kaur
DOI: 10.4236/jct.2011.22031   PDF    HTML     10,004 Downloads   18,034 Views   Citations


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.

Share and Cite:

D. Yildirim, B. Gurses, B. Ekci and A. Kaur, "Power Doppler Vocal Fremitus Breast Sonography: Differential Diagnosis with a New Classification Scheme—Power Doppler Vocal Fremitus Examination of Breast Lesions," Journal of Cancer Therapy, Vol. 2 No. 2, 2011, pp. 243-252. doi: 10.4236/jct.2011.22031.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] R. F. Chang, S. F. Huang, W. K. Moon, Y. H. Lee and D. R. Chen, “Solid Breast Masses: Neural Network Analysis of Vascular Features at Three-Dimensional Power Doppler US for Benign or Malignant Classification,” Radiology, Vol. 243, April 2007, pp. 56-62. doi:10.1148/radiol.2431060041
[2] Y. L. Huang, S. J. Kuo, C. C. Hsu, H. S. Tseng, Y. H. Hsiao and D. R. Chen, “Computer-Aided Diagnosis for Breast Tumors by Using Vascularization of 3-D Power Doppler Ultrasound,” Ultrasound in Medicine and Biology, Vol. 35, No. 10, October 2009, pp. 1607-1614. doi:10.1016/j.ultrasmedbio.2009.05.014
[3] Y. H. Hsiao, Y. L. Huang, W. M. Liang, C. Lin, S. J. Kuo and D. R. Chen, “Characterization of Benign and Malignant Solid Breast Masses: Harmonic Versus Nonharmonic 3D Power Doppler Imaging,” Ultrasound in Medicine and Biology, Vol. 35, No. 3, March 2009, pp. 353-359. doi:10.1016/j.ultrasmedbio.2008.09.010
[4] C. Weismann and K. Hergan, “Current Status of 3D/4D Volume Ultrasound of the Breast,” Ultrasound in Medicine, Vol. 28, No. 3, 2007, pp. 273-282. doi:10.1055/s-2007-963225
[5] H. Reinikainen, T. Rissanen, M. P?iv?nsalo, E. P??kk?, J. Jauhiainen and I. Suramo, “B-Mode, Power Doppler and Contrast-Enhanced Power Doppler Ultrasonography in the Diagnosis of Breast Tumors,” Acta Radiologica, Vol. 42, No. 1, 2001, pp. 106-113. doi:10.1080/028418501127346341
[6] K. R. Cho, B. K. Seo, Y. J. Lee, E. D. Pisano, B. K. Je, J. Y. Lee, E. J. Choi, K. B. Chung and O. Y. Whan, “A Comparative Study of 2D and 3D Ultrasonography for Evaluation of Solid Breast Masses,” European Journal of Radiology, Vol. 54, No. 3, June 2005, pp. 365-370. doi:10.1016/j.ejrad.2004.07.006
[7] A. T. Stavros, D. Thickman, C. L. Rapp, et al. “Solid Breast Nodules: Use of Sonography to Distinguish between Benign and Malignant Lesions,” Radiology, Vol. 196, 1995, pp. 123-134.
[8] W. E. Svensson, “The Use of Color Doppler Vascular Morphology in Improving the Ultrasound Diagnosis of Breast Lesions,” Acta Clinica Croatica, Vol. 41, No. 2, 2002, pp. 99-100.
[9] P. Milz, A. Lienemann, M. Kessler and M. Reiser, “Evaluation of Breast Lesions by Power Doppler Sonography,” European Radiology, Vol. 11, No. 4, 2001, pp. 547-554. doi:10.1007/s003300000733
[10] R. L. Birdwell, D. M. Ikeda, S. S. Jeffrey and R. B. Jeffrey, “Preliminary Experience with Power Doppler Imaging of Solid Breast Masses,” American Journal of Roentgenolgy, Vol. 169, 1997, pp. 703-707.
[11] G. M. Giuseppetti, S. Baldassarre and E. Marconi, “Color Doppler Sonography,” European Journal of Radiology, Vol. 27, No. 2 (Supplement), May 1998, pp. 254-258. doi:10.1016/S0720-048X(98)00076-X
[12] S. W. Lee, H. Y. Choi, S. Y. Baek and S. M. Lim, “Role of Color and Power Doppler Imaging in Differantiating between Malignant and Benign Solid Breast Diseases,” Journal of Clinical Ultrasound, Vol. 30, No. 8, 2002, pp. 459-464. doi:10.1002/jcu.10100
[13] L. Alamo and U. Fischer, “Contrast-Enhanced Color Doppler Ultrasound Characteristics in Hypervascular Breast Tumors: Comparison with MRI,” European Radiology, Vol. 11, No. 6, 2001, pp. 970-977. doi:10.1007/s003300000691
[14] S. Huber, M. Vesely, I. Zuna, S. Delorme and H. Czembirek, “Fibroadenomas: Computer-Assisted Quantitative Evaluation of Contrast-Enhanced Power Doppler Features and Correlation with Histopathology,” Ultrasound in Medicine and Biology, Vol. 27, No. 1, January 2001, pp. 3-11. doi:10.1016/S0301-5629(00)00282-9
[15] S. H. Kook, H. W. Park and Y. R Lee, “Evaluation of Solid Breast Lesions with Power Doppler Sonography,” Journal of Clinical Ultrasound, Vol. 27, No. 5, 1999, pp. 231-237. doi:10.1002/(SICI)1097-0096(199906)27:5<231::AID-JCU2>3.0.CO;2-P
[16] C. Sohn, A. Baudendistel and G. Bastert, “Diagnosis of the Breast Tumor Entity with ‘Vocal Fremitus’ in Ultrasound Diagnosis,” Bildgebung, Vol. 61, No. 4, 1994, pp. 291-294.
[17] C. Sohn and A. Baudendistel, “Differential Diagnosis of Mammary Tumors with Vocal Fremitus in Sonography: Preliminary Report,” Ultrasound in Obstetrics & Gynecology, Vol. 6, No. 3, 1995, pp. 205-207. doi:10.1046/j.1469-0705.1995.06030205.x
[18] A. T. Stavros, “Doppler Evaluation of the Breast,” In: A. T. Stavros, Ed. Breast Ultrasound, 1st Edition, Lippincott, Williams & Wilkins, Philadelphia, 2003, pp. 920-946.
[19] S. P. Weinstein, E. F. Conant and C. Sehgal, “Technical Advances in Breast Ultrasound Imaging,” Seminars in Ultrasound, CT and MRI, Vol. 27, No. 4, August 2006, pp. 273-283. doi:10.1053/j.sult.2006.05.002
[20] I. Y. Whang, “Power Doppler Needle-Induced Fremitus for Breast Localization,” Archives of Gynecology and Obstetrics, Vol. 278, No. 4, 2008, pp. 337-340. doi:10.1007/s00404-008-0583-x
[21] S. P. Weinstein, C. Seghal, E. F. Conant and J. A. Patton, “Microcalcifications in Breast Tissue Phantoms Visualized with Acoustic Resonance Coupled with Power Doppler US: Initial Observations,” Radiology, Vol. 224, No. 1, 2002, pp. 265-269. doi:10.1148/radiol.2241010511
[22] M. J. Kim, E. K. Kim, H. J. Youk, J. Y. Lee, B. M. Kim and K. K. Oh, “Application of Power Doppler Vocal Fremitus Sonography in Breast Lesions,” Journal of Ultrasound in Medicine, Vol. 25, No. 7, 2006, pp. 897-906.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.