Abstract
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.
References
- Park K, Epidemiology of chronic non-communicable disease and conditions. Park’s Textbook of Preventive and Social Medicine, 16th Jabalpur: M/S B D Bhanot, 2000: 283-292.
- Frankl G, Ackerman M, Xeromammography and 1200 breast cancers. RCNA 1983; 21:1,81-91.
- Martin JE, Breast imaging techniques. Mammography, ultrasonography, computed tomography, thermography and transillumination. RCNA 1983; 21:1,149-153.
- Tabar L, Fagerberg G, Duffy S, Day N, Gad A, Grontoff O, Update of the Swedish two-country program of mammographic screening for breast cancer. RCNA 1992; 30:1,187-210.
- Basset LW, Imaging of breast masses. RCNA 2000; 38:669-691.
- Parker SH, Jobe WE, Dennis MA, et al. US guided automated large-core breast biopsy. Radiology 1993;187: 507-511.
- Gallager HS, Martin JE, The study of mammary carcinoma by mammography and whole organ sectioning. Cancer 1969; 23:4, 855-873.
- Sadowsky N., Kopans DB, Breast cancer. RCNA 1983; 21:1,51-65.
- Sickles EA, Mammographic features of early breast cancer. AJR1984; 143: 461-464.
- Pandya MP, Wanchoo PK, Udawat JP, Sharma GC, Mammography-preliminary experience with 50 cases. Indian Journal of Surgery 1974; 102-106.
- Samuel E, Diagnostic radiology in diagnosis of carcinoma of the breast. J. Surgery 1964; 51: 3,221-224.
- Leborgne R, Diagnosis of tumours of the breast by simple roentgenography. The American Journal of reontgenography and radium therapy 1951; 65:1,1-11.
- Egan RL, Mammography: Report on 2000 studies. Surgery 1963; 53:3, 291-302.
- Ciatto S, Cataloitti L. Distante V, Non-palpable lesions detected with mammography: Review of 512 consecutive cases. Radiology 1987; 165: 99-102.
- Sickles EA, Further experience with microfocal spot magnification mammography in the assessment of clustered microcalcifications. Radiology 1980; 137: 9-14.
- de Paredes ES, Marsteller LP, Eden BV, Breast cancers in women 35 years of age and younger: Mammographic findings. Radiology 1990; 177:117-119.
- Skaane P, Engedal K, Analysis of sonographic features in the differentiation of fibroadenoma and invasive ductal carcinoma. AJR 1998; 170:109-114
- Maturo VG, Zusmer NR, Gilson AJ, Bear M, Ultrasonic appearance of mammary carcinoma with a dedicated whole breast scanner. Radiology 1982; 142:713-718.
- Cole-Beuglet C, Soriano RZ, Kurtz AB, Gold berg BB, Ultrasound analysis of 104 primary breast carcinomas classified according to histopathologic type. Radiology 1983; 147:191-196.
- Jokich PM, Monticciolo DL, Adler YT, Breast ultrasonography. RCNA 1992; 30:5, 993-1009.
- Egan RL, Egan KL, Automated water-path full breast sonography: correlation with histology of 176 solid lesions. AJR 1984;143:499-507.
- Wolfe JN, Mammography: Report on its use in women with breasts abnormal and normal on physical examination. Pro le summario in inter lingua 1964; 83:244-254.
- 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? Clinical Radiology 1999; 54:676-682.
- Houssami N, Irwig L, Simpson JM, Mc Kessar M, Blome S, Noakes J, Sydney breast imaging accuracy study: comparative sensitivity and specifity of mammography and sonography in young women with symptoms. AJR 2003;180:935-940.
Corresponding Author
Dr Ashwani Tomar
DOI: https://dx.doi.org/10.18535/jmscr/v6i3.62
