A Comparative Study of Mammography and Sonomammography with Histopathology in Evaluating Palpable Breast Masses

Abstract

Introduction: Breast lump is the clinical presentation of various breast diseases that range from benign cyst to malignant lesions. Differentiation of benign from malignant is the most important aspect for patient care and proper management. Aim: To evaluate the mammographic and sonomammographic features of the clinically palpable breast masses. To characterize the breast masses into benign and malignant based on mammographic, sonographic findings and to compare imaging findings with histopathology. Materials and Methods: This prospective study was conducted in the Department of Radiodiagnosis, Mysore Medical College, for duration of one year. Sixty women, above 30 years of age with palpable breast mass were evaluated by mammography and sonomammmography, followed by histopathology. Diagnostic accuracy was calculated in terms of sensitivity, specificity, positive predictive value, negative predictive value for mammography, sonography individually and in combination. Results: Present study revealed 37 benign and 23 malignant cases on histopathological analysis. Of 60 palpable masses, mammography detected 52 cases and eight were occult. Ninety percent of the mammographically malignant cases were proved to be malignant on histopathology and 96.8% of mammographically benign cases were benign on histopathology, resulting in sensitivity, specificity, PPV and NPV of 94.7%, 93.9%, 90% and 91.2% respectively. Sonomammography was normal in two of the patients and 39 of the 58 sonomammographically detected lesions were solid and rest were cystic or predominantly cystic lesions. Ninety one percent of the sonomammographically malignant cases were proved to be malignant on histopathology and 97.1% of sonomammographically benign cases were benign on histopathology, resulting in sensitivity, specificity, PPV and NPV of 95.4%, 94.4%, 91.3% and 97.1%, respectively. Combining mammography with sonomammmography yielded better characterization of mass lesions with sensitivity and NPV of 100.0% and increased specificity and PPV of 94.6% and 92% respectively. Conclusion: Imaging has an important role in the management of palpable breast masses. Combined use of mammography and sonomammography provides very high diagnostic accuracy, helps in better characterisation of palpable lesions, reduces patient anxiety and avoids unnecessary interventions in cases where imaging findings are unequivocally benign.

Keywords

• benign
• breast lump
• malignant
• sensitivity
• specificity