Journal of Ultrasound in Medicine, Vol 15, Issue 9 637-644, Copyright © 1996 by American Institute of Ultrasound in Medicine
Role of high frequency ultrasonography in the evaluation of palpable breast masses in Chinese women: alternative to mammography?
W. T. Yang, C. O. Mok, W. King, A. Tang and C. Metreweli
Department of Diagnostic Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
We prospectively assessed the accuracy of high resolution breast
ultrasonography in the diagnosis of palpable breast masses in comparison to
clinical palpation and x-ray mammography. Four hundred and eight Chinese
women with palpable breast lumps had clinical assessment followed by
ultrasonography of the breast, mammography (for women over 35 years), and
fine needle aspiration cytology. Excisional biopsy or surgery was performed
for suggestive lesions. The clinical, mammographic and ultrasound diagnoses
were compared with the final pathologic diagnosis. In the determination of
whether a lesion was malignant, the sensitivity, specificity, and positive
predictive values were 97%, 97%, and 85%, respectively, for
ultrasonography; 92%, 94%, and 84%, respectively, for mammography; and 88%,
92%, and 67%, respectively, for clinical evaluation. The specificity for
combined clinical palpation and ultrasonography was higher (99%) than that
for combined clinical palpation and mammography (96%). Addition of
ultrasonography to combined clinical palpation and mammography increased
specificity. Mammography in addition to combined clinical palpation and
ultrasonography did not significantly improve the sensitivity, specificity,
or positive predictive value. This limited usefulness raises the question
as to whether it should be eliminated in the workup of a palpable mass in
the average Chinese patient. Its main advantage is the detection of
extended foci of carcinoma in situ related to a palpable mass, which often
is undetected by ultrasonography.
