Ultrasound characterization of breast masses

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Abstract

A lump in the breast is a cause of great concern. High frequency, high-resolution USG helps in its evaluation. This is exemplified in women with dense breast tissue where USG is useful in detecting small breast cancers that are not seen on mammography. Several studies in the past have addressed the issue of differentiating benign from malignant lesions in the breast. The American College of Radiology has also brought out a BIRADS-US classification system for categorizing focal breast lesions.

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Solid breast nodules: use of sonography to distinguish between benign and malignant lesions.

A T Stavros, D Thickman, C Rapp … (1995)

To determine whether sonography could help accurately distinguish benign solid breast nodules from indeterminate or malignant nodules and whether this distinction could be definite enough to obviate biopsy. Seven hundred fifty sonographically solid breast nodules were prospectively classified as benign, indeterminate, or malignant. Benign nodules had no malignant characteristics and had either intense homogeneous hyperechogenicity or a thin echogenic pseudocapsule with an ellipsoid shape or fewer than four gentle lobulations. Sonographic classifications were compared with biopsy results. The sensitivity, specificity, and negative and positive predictive values of the classifications were calculated. Benign histologic features were found in 625 (83%) lesions; malignant histologic features, in 125 (17%). Of benign lesions, 424 had been prospectively classified as benign. Two lesions classified as benign were found to be malignant at biopsy. Thus, the classification scheme had a negative predictive value of 99.5%. Of 125 malignant lesions, 123 were correctly classified as indeterminate or malignant (98.4% sensitivity). Sonography can be used to accurately classify some solid lesions as benign, allowing imaging follow-up rather than biopsy.

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Using sonography to screen women with mammographically dense breasts.

J Koretz, Semyon Shcharynski, Michael Strano … (2003)

Mammographically dense breast tissue has been reported both as a cause of false-negative findings on mammography and as an indicator of increased breast cancer risk. We conducted this study to evaluate the role of breast sonography as a second-line screening test in women with mammographically dense breast tissue. Between January 2000 and January 2002, 1517 asymptomatic women with dense breasts and normal mammography and physical examination findings underwent physician-performed breast sonography as an adjunct screening test. Within the study group, 318 women had a first-degree family history or personal history of breast cancer. The high-risk subgroup comprised these women. The detection rate of breast cancer in this subgroup was compared with the detection rate in the remaining study population with baseline risk. Of 1517 women examined, seven breast cancers were diagnosed (cancer-detection rate, 0.46%). Four carcinomas were detected in high-risk women and three in women with baseline risk. The cancer-detection rate in the subgroup of high-risk women was 1.3%, significantly higher (p < 0.04) than the cancer-detection rate of 0.25% in the baseline risk subgroup. All cancers were T1 (range, 4-12 mm; mean, 9.6 mm). Sentinel lymph nodes were negative for cancer in six of seven carcinomas. Screening breast sonography in the population of women with dense breast tissue is useful in detecting small breast cancers that are not detected on mammography or clinical breast examination. The use of sonography as an adjunct to screening mammography in women with increased risk of breast cancer and dense breasts may be especially beneficial.

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Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions.

Qing Hui Zhi, Hai Yang, Ming Luo … (2007)

The purpose of this study was to evaluate the value of ultrasound elastography (UE) in differentiating benign versus malignant lesions in the breast and compare it with conventional sonography and mammography. From September 2004 to May 2005, 296 solid lesions from 232 consecutive patients were diagnosed as benign or malignant by mammography and sonography and further analyzed with UE. The diagnostic results were compared with histopathologic findings. The sensitivity, specificity, accuracy, positive and negative predictive values, and false-positive and -negative rates were calculated for each modality and the combination of UE and sonography. Of 296 lesions, 87 were histologically malignant, and 209 were benign. Ultrasound elastography was the most specific (95.7%) and had the lowest false-positive rate (4.3%) of the 3 modalities. The accuracy (88.2%) and positive predictive value (87.1%) of UE were higher than those of sonography (72.6% and 52.5%, respectively). The sensitivity values, negative predictive values, and false negative rates of the 3 modalities had no differences. A combination of UE and sonography had the best sensitivity (89.7%) and accuracy (93.9%) and the lowest false-negative rate (9.2%). The specificity (95.7%) and positive predictive value (89.7%) of the combination were better, and the false-positive rate (4.3%) of the combination was lower than those of mammography and sonography. In a clinical trial with Chinese women, UE was superior to sonography and equal or superior to mammography in differentiating benign and malignant lesions in the breast. A combination of UE and sonography had the best results in detecting cancer and potentially could reduce unnecessary biopsy. Ultrasound elastography is a promising technique for evaluating breast lesions.

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Journal

Journal ID (nlm-ta): Indian J Radiol Imaging

Journal ID (publisher-id): IJRI

Title: The Indian Journal of Radiology & Imaging

Publisher: Medknow Publications (India )

ISSN (Print): 0971-3026

ISSN (Electronic): 1998-3808

Publication date (Print): August 2009

Volume: 19

Issue: 3

Pages: 242-247

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Dr Gokhale's Sonography clinic, Indore, India

Author notes

Correspondence: Dr Sudheer Gokhale, 53 Wasudevnagar, Indore, 452004, India. E-mail: sudheergokhale@ 123456hotmail.com

Article

Publisher ID: IJRI-19-242

DOI: 10.4103/0971-3026.54878

PMC ID: 2766883

PubMed ID: 19881096

SO-VID: 672bf98d-5e2f-4398-b1be-3ca875fab1e1

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ultrasound characterization of breast masses

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Abstract

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Most cited references 25

Solid breast nodules: use of sonography to distinguish between benign and malignant lesions.

Using sonography to screen women with mammographically dense breasts.

Comparison of ultrasound elastography, mammography, and sonography in the diagnosis of solid breast lesions.

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