Diagnostic Accuracy of Combining Sonoelastography with Mammography in Solid Breast Lesions Keeping Histopathology as Gold Standard

Abstract

Background and objective: Breast cancer is the most common malignancy in females. Early diagnosis can help in reducing the morbidity and mortality associated with this disease. Sonoelastography has shown to be a valuable tool in early detection of breast cancer. The aim of the study was to evaluate the diagnostic accuracy of combining sonoelastography with mammography in diagnosing malignant solid breast lesions taking histopathology as a gold standard.Methods: A descriptive cross-sectional study was carried out at the Department of Radiology, Shaikh Zayed Medical Complex/Federal Post-Gradaute Medical Institute (FPGMI), Lahore, Pakistan during six months period from 1st September, 2018 to 31st March, 2019. Female patients > 35 years of age and presenting with suspected malignant breast masses were included. Mammography and sonoelastography of the lesions were done. Finally, the patients were referred for tru cut biopsy. Diagnostic accuracy was calculated for mammography, sonoelastography and their combination.Results: A total of 200 female patients were enrolled with a mean age of 50.8 (± 8.6) years. Mammographic findings suggestive of malignancy (BI-RADS category IV and V) were present in 96 (48%) cases. Elastography showed finding of malignancy (Score 4 and 5) in 96 (48%) cases. Combined sonoelastography and mammography diagnosed malignancy in 112 (56%) cases. Histopathologically confirmed malignancy was seen in 110 (55%) cases. The sensitivity and specificity of mammography (76.3 % and 77.7%) and sonoelastography (77.3% and 87.7%), were comparable. The combination of mammography and sonoelastography showed a higher sensitivity (90.9%) and specificity (86.6%). The combination showed a diagnostic accuracy of 89% followed by sonoelastography (82%) and mammography (77%) alone.Conclusion: Combination of sonoelastography and mammography can significantly enhance the diagnostic accuracy of breast carcinoma. Females may be offered mammography or ultrasonography in combination with sonoelastography for routine testing.