Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2007, 151(2):315-322 | DOI: 10.5507/bp.2007.054
A comparison of mammography and ultrasonography in the evaluation of breast masses
- Department of Radiology*, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
Aim: Aim of the study is to evaluate breast masses using mammography (MG) and ultrasonography (USG) independently and in combination.
Materials and methods: Our study group consisted of 62 female patients, with breast symptoms such as palpable lumps, pain in the breast and nipple discharge who were examined prospectively over a period of 6 months. All 62 patients were examined by both MG and USG independently. Fine needle aspiration cytology (FNAC) or core cut biopsy was done according to the findings of MG and USG and then the results were correlated with each modality finding.
Results: According to this study MG showed an efficiency of 81.8 % compared to 95.5 % for USG in detecting fibrocystic mastitis. However their combined approach resulted in 100 %. In the case of fibroadenomas, MG showed 75 % efficiency and USG only 35 % and the combination resulting in 93.7 %. For carcinomas, MG had an efficiency of 77.8 % and USG 55.6 %, but the combination had an efficiency of 98.1 %. Overall, the histopathological results when correlated with each modality finding showed that MG had an efficiency of only 77.4 % and USG only 69.8 % when used alone in detecting these lesions of the breast compared to an efficiency of 98.1 % obtained by their combined approach. In our study, we showed that there was no significant difference in sensitivity between MG and USG (p = 0.3768) but there was significant difference in MG alone and MG-USG combination (p = 0.0015) and USG alone and USG-MG combination (p = 0.0001).
Conclusion: Our study confirmed that combined MG and USG had higher sensitivity rate than the sensitivity rate observed for either single modality. The diagnostic accuracy for carcinomas of the breast appear to improve when MG was combined with USG, even in cases which showed no evidence of microcalcification or other signs of abnormalities. Our study implies that, USG may be the only viable modality in pregnant and lactating women as it does not involve ionizing radiation and also in dense breast tissue, as density is a limiting factor for MG.
Keywords: Keywords: Mammography, Ultrasonography, Breast masses, FNAC, Breast cancer
Received: October 10, 2007; Accepted: November 2, 2007; Published: December 1, 2007 Show citation
References
- Clarke D, Sudhakaran N, Gateley CA. Replace fi ne needle aspiration cytology with automated core biopsy in the triple assessment of breast cancer. Ann R Coll Surg Engl 2001; 83:1102.
- Schoonjans JM, Brem RF. Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses. J Ultrasound Med 2001; 20:96772
Go to original source...
Go to PubMed...
- Morris KT, Vetto JT, Petty JK, Lum SS, Schmidt WA, Toth-Fejel S, et al. A new score for the evaluation of palpable breast masses in women under age 40. Am J Surg 2002; 184:3467.
Go to original source...
Go to PubMed...
- Wendie A. Berg, MD, PhD, Lorena Gutierrez, MD, Moriel S. NessAiver, PhD, W. Bradford Carter, MD2, Mythreyi Bhargavan, PhD, Rebecca S. Lewis, MPH and Olga B. Ioff e, MD Diagnostic Accuracy of mammography, Clinical Examination, US, and MR Imaging in Preoperative Assessment of Breast Cancer1 radiology. rsnajnls.org/cgi/content/abstract/233/3/830
- Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D. Ann Intern Med. 2003 Aug 19; 139(4): 27484. Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med. 2003 Aug 19; 139(4): 27484.
Go to original source...
Go to PubMed...
- Kopans DB. Breast imaging. Philadelphia: Lippincott, 1998:29 54
- Chakraborti KL, Bahl P, Sahoo M, Ganguly SK, Oberoi C. Magentic resonance imaging of breast masses: Comparison with mammography. Indian J Radiol Imaging 2005; 15:381387
Go to original source...
- Pande AR, Lohani B, Sayami P, Pradhan S.Predictive value of ultrasonography in the diagnosis of palpable breast lump. Kathmandu Univ Med J (KUMJ). 2003 Apr-Jun; 1(2): 7884.
- Fajardo LL. Screening mammography, sonography of dense fi - brocystic breast tissue. AJR Am J Roentgenol. 2003 Dec; 181(6): 1715.
Go to original source...
Go to PubMed...
- Dennis MA, Parker SH, Klaus AJ, Stavros AT, Kaske TI, Clark SB. Breast biopsy avoidance: the value of normal mammograms and normal sonograms in the setting of a palpable lump. Radiology 2001; 219:186 -191
Go to original source...
Go to PubMed...
- Weinstein SP, Conant EF, Orel SG, Zuckerman JA, Czerniecki B, Lawton TJ. Retrospective review of palpable breast lesions after negative mammography and sonography. J Women's Imaging 2000; 2:1518
- Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D. Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med 2003; 139:27484.
Go to original source...
Go to PubMed...
- Shetty MK, Shah YP, Sharman RS. Prospective evaluation of the value of combined mammographic and sonographic assessment in patients with palpable abnormalities of the breast. J Ultrasound Med 2003; 22:2638.
Go to original source...
Go to PubMed...
- Kumle M, Weiderpass E, Braaten T, Persson I, Adami HO, Lund E. Use of oral contraceptives and breast cancer risk: the Norwegian- Swedish Women's Lifestyle and Health Cohort Study. Cancer Epidemiol Biomarkers Prev 2002; 11:137581.
- Budai B, Szamel I, Sulyok Z, Nemet M, Bak M, Otto S, et al. Characteristics of cystic breast disease with special regard to breast cancer development. Anticancer Res 2001; 21:74952.
- Barton MB, Harris R, Fletcher SW. The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA 1999; 282:127080.
Go to original source...
Go to PubMed...
- Osuch JR, Reeves MJ, Pathak DR, Kinchelow T. BREASTAID: clinical results from early development of a clinical decision rule for palpable solid breast masses. Ann Surg 2003; 238:72837.
Go to original source...
Go to PubMed...
- Moss HA, Britton PD, Flower CD, Freeman AH, Lomas DJ; Warren RM. How reliable is modern breast imaging in diff erentiating benign from malignant breast lesions in the symptomatic population? Clin Radiol 1999; 54:67682.
Go to original source...
Go to PubMed...
- Berg WA, Campassi CI, Ioff e OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology 2003; 227:18391.
Go to original source...
Go to PubMed...
- Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that infl uence them: an analysis of 27,825 patient evaluations. Radiology 2002; 225:16575.
Go to original source...
Go to PubMed...
- Lister D, Evans AJ, Burrell HC, Blamey RW, Wilson AR, Pinder SE, et al. The accuracy of breast ultrasound in the evaluation of clinically benign discrete, symptomatic breast lumps. Clin Radiol 1998; 53:4902.
Go to original source...
Go to PubMed...
- Barlow WE, Lehman CD, Zheng Y, Ballard-Barbash R, Yankaskas BC, Cutter GR, et al. Performance of diagnostic mammography for women with signs or symptoms of breast cancer. J Natl Cancer Inst 2002; 94:11519.
Go to original source...
- Leichter I, Buchbinder S, Bamberger P, Novak B, Fields S, Lederman R. Quantitative characterization of mass lesions on digitized mammograms for computer-assisted diagnosis. Invest Radiol 2000; 35:36672.
Go to original source...
Go to PubMed...
- Obenauer S, Luftner-Nagel S, von Heyden D, Munzel U, Baum F, Grabbe E. Screen fi lm vs full-fi eld digital mammography: image quality, detectability and characterization of lesions [published correction appears in Eur Radiol 2002; 12:2388]. Eur Radiol 2002; 12:1697702.
Go to original source...
- Lewin JM, Hendrick RE, D'Orsi CJ, Isaacs PK, Moss LJ, Karellas A, et al. Comparison of full-fi eld digital mammography with screenfi lm mammography for cancer detection: results of 4,945 paired examinations. Radiology 2001; 218:87380.
Go to original source...
Go to PubMed...
- Westenend PJ, Sever AR, Beekman-De Volder HJ, Liem SJ. A comparison of aspiration cytology and core needle biopsy in the evaluation of breast lesions. Cancer 2001; 93:14650.
Go to original source...
Go to PubMed...