Colour Doppler-An Evaluation Tool for Assessment of Breast Tumour Size, Axillary Lymph Node Size and Chemotherapeutic Response

Abstract

Aims: The present study was taken up in carcinoma breast patients to evaluate clinical examination and Colour Doppler in estimating the breast tumour size, axillary lymph node size and chemotherapeutic response, taking histopathological examination as the gold standard. Material & Methods: The study carried out between December 2008 to June 2010 included 37 patients. Ethics committee clearance obtained. Chemotherapeutic response could be assessed in 24 patients who received chemotherapy prior to surgery. 13 patients were taken up directly for surgery. Clinical, sonological and histopathological largest dimension of the primary tumour and axillary lymph nodes were assessed. Chemotherapy response grades were assessed as per criteria given by Kumar A et al. Results were analyzed using paired-t test, weighted kappa and Spearman correlation coefficient. Results: The difference between mean clinical and histopathological size of breast tumour of 0.01cm, was statistically not significant (t=.064, p=.949). However, the difference between mean sonological and histopathological size of breast tumour of 1.10cm, was statistically highly significant (t=-3.93, p<.001). For axillary lymph nodes, the mean difference between clinical and histopathological assessment was 0.46 cm (p=0.007) as against mean difference of 0.48 cm between sonological and histopathological assessment (p=0.001). Clinical response showed substantial agreement with histopathological response in breast tumour (k=0.657; p=0.001) and axillary lymph nodes (k=0.62; p<0.005). Sonological response showed moderate agreement (k=0.510; p< 0.02) in breast tumour and substantial agreement (k=0.691; p<0.001) in axillary lymph nodes. Compared to histopathological response, RI, PI and Vmax response showed moderate agreement in primary and substantial agreement in axillary lymph nodes. Conclusion: In the present study, sonology was found to be a poor modality for breast tumour size, axillary lymph node size estimation. With regard to chemotherapy response assessment, clinical examination was a better modality for primary, while Colour Doppler was better for axillary lymph node evaluation.