Abstract
Aim & Objectives:To evaluate the role of combined mammographic and sonographic imaging in patients with palpable masses of the breast.To correlate these findings with histopathological diagnosis (FNAC/ Biopsy). To provide systematic and practical approach to image evaluation of palpable breast masses and then evaluate its image characteristics which help in decision making by clinician as to go for biopsy or lesion follow up.
Materials and Methods:40 patients aged 30 or above with palpable abnormalities of breast underwent combined mammographic and sonographic evaluation.
Results:18 patients (45%) of the palpable abnormalities had benign result and 8 patients (20%) had malignant result. Imaging evaluation resulted in 14 (35%) patients as suspicious cases. All lesions categorized as suspicious underwent biopsy, among them 12 resulted in malignancy and 2 benign findings. The sensitivity and specificity of combined evaluation is 85.7% and 100% respectively. The positive predictive value and negative predictive value are 100% and 86.4% respectively. In this evaluation, NPV was 86.4%, a negative test result provides reassurance that the patient is unlikely to have cancer.
Conclusion:Combined mammography and sonography is appropriate to characterize the palpable breast lesion and avoids unnecessary interventions in which imaging findings are unequivocally benign. Negative findings on combined mammographic and sonographic imaging have very high specificity and are reassuring to the patient.
Keywords: Biopsy; breast; mammography; palpable lumps; sonography.
References
1. Prasad SN, Houserkova D, A comparison of mammography and ultrasonography in the evaluation of breast masses. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007 Dec; 151(2):315-22.
2. Prasad SN, The role of various modalities in breast imaging. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub.2007 Dec; 151(2):209-18
3. Bennett IC, Freitas R Jr, Fentiman IS :Diagnosis of breast cancer in young women.Avst NZJ Surg61:284-289,1991
4. Barton MB ,Elmore JG ,Fletcher SW .Breast symptoms among women enrolled in a health maintainaence organisation.Frequency,evaluation and outcome .Ann intern Med 1999 Apr 20; 130 (8):651-657
5. Perdue P,page D, Nellestein m,salem C,Galbo c,ghosh B.Early detection of breast carcinoma ;a comparision of palpable and non palpable lesions : Surgery 1992;111(6):656-659
6. Conveys EC, Geraghty JG ,O ‘Laoide R,Hourihane IB,O’Higgins NJ .Reasons underlying negative mammography in patients with palpable breast cancer .clin.radiology1994:49(2):123-125
7. Soo MS, Rosen EI, Baker JA, Vo TT, Boyd BA .Negative predictive value of sonography with mammography in patients with palpable breast lesions.AJR AmJ Roentgenol 2001;177;1167 -1170
8. Moy L,slantez PJ, Moore R et al .Specificity of mammography and US in the evaluation of a palpable abnormality 2002:225:176-181
9. Morris KT, Vetto JT, Petty JK, Lum SS, Schmidt WA, Toth-Fejel S and colleagues. A new score for the evaluation of palpable breast masses in women under age 40. American journal of surgery 2002; 184:245-7
10. Ahmed I, Nazir R, Chaudhary MY, Kundi S, Triple assessment of breast lump. J Coll Physicians Surg Pak. 2007 Sep;17(9):535-8
11. Lister D, Evans AJ, Burrell HC, Blamey RW, Wilson AR, Pinder SE, and collegues. The accuracy of breast ultrasound in the evaluation of clinically benign discrete, symptomatic breast lumps. Clin Radiol 1998; 53:490–2.
12. Moss HA, Britton PD, Flower CDR, Freeman AH, Lomas DJ, Warren RML. How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population? Clin Radiol 1999; 54(10):676–682.
13. Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002; 225:165–175.
14. Shetty MK & Shah YP, Sharman RS. Prospective evaluation of value of combined mammographic and sonographic assessment in patients with palpable abnormalities of breast. J. Ultrasound Med 2003:22;263-268.
15. Barlow WE, Lehman CD, Zheng Y, et al. Performance of diagnostic mammography for women with signs or symptoms of breast cancer. J Natl Cancer Inst 2002; 94:1151-9.