Objective: Evaluation of breast masses with mammography and sonography and comparison with Fine Needle Aspiration Cytology (FNAC)/ histopathology examination.

Materials and Method: The study consisted of 25 women with incidentally detected breast masses in hilly population of Himachal Pradesh in 1 year period, in the age range of 24 to 70 years. Mammography of the symptomatic breast was done first and two standard views i.e. craniocaudal (CC) and mediolateral oblique (MLO) were obtained. All patients were then subjected to real time ultrasound scanning with 7.5 MHz linear array transducer. FNAC was done in all cases and histopathological examination was performed on all operated specimens.

Results: Out of 25 patients, mammography alone characterized 18 patients as having malignant lesions and seven as having benign masses.

By using sonography alone 15 patients were diagnosed as having malignant masses, nine had benign lesions and one lesion was indeterminate. When mammography and sonography were combined together, 17 patients were diagnosed as having malignant masses and eight patients as benign masses.

On mammography, the most characteristic feature of malignant lesions was a spiculated mass in 75% cases or irregular margins in 25% cases. Mare’s tail was seen in 19% cases and denotes a malignant pathology. On sonography, the contour of malignant masses was irregular in 88% and smooth in 12%. Margins of benign masses were smooth (67%), irregular (22%) or were not made out in (11%). In benign masses, the contour was smooth in 56%, irregular in 33% and a pseudocapsule was seen in 11%. 94% of the masses were hypoechoic in appearance and 6% masses showed extensive hypoechogenicity. Edge shadowing was present in 63%, extensive posterior shadowing in 6% and neutral sound transmission was seen in 31% malignant lesions. Sound transmission was neutral in 78% and edge shadowing was present in 22% benign masses.

Malignant masses were of high density in 94% and of mixed density in 6% patients. On the other hand, high density was seen in 67% benign masses and mixed density in 33%. Microcalcifications were present in 19% malignant masses and macrocalcifications were seen in 4% benign masses.

Conclusion: Mammography is the initial imaging investigation of choice for detection and characterization of breast masses. Sonography is a useful adjunct to mammography for evaluating breast lesions. Combined evaluation of breast masses with mammography and sonography gives higher accuracy rate than either method alone.

Keywords: Breast masses, mammography, sonography.

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Dr Ashwani Tomar