Three-dimensional Doppler Indices for Breast Masses: Systematic Review of Diagnostic Test Accuracy

Our objective was to assess the diagnostic accuracy of three-dimensional power Doppler (3DPD) indices (vascularization index, flow index, vascularization flow index) in distinguishing between benign and malignant breast masses by performing a systematic review of the current literature. The following databases were searched from their inception until October 18, 2012: Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Medical Literature Analysis and Retrieval System Online, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Literatura Latino-Americana e do Caribe em Ciências da Saúde. Studies were considered eligible if they met the following criteria: (1) they evaluated the diagnostic accuracy of at least one of the 3D Doppler indices to differentiate benign from malignant breast masses; (2) cytology or/and histology was used as the reference standard to determine malignancy; (3) the number of true positives, false positives, true negatives, and false negatives could be retrieved. This search resulted in only one eligible study. This study evaluated a relatively large sample size, and we did not have any concern regarding applicability or risk of bias when evaluating its quality. The results show that adding 3DPD indices only slightly improved the diagnostic test accuracy in distinguishing benign and malign breast masses in women with suspicious breast masses requiring biopsy. We concluded that although 3DPD indices seem to be able to help in distinguishing between benign and malignant breast masses, there is still insufficient evidence to suggest using this method in clinical practice. More good-quality studies evaluating the diagnostic accuracy of this method are still required.