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Prospective Evaluation of the Value of Combined Mammographic and Sonographic Assessment in Patients With Palpable Abnormalities of the Breast

Department of Radiology, Baylor College of Medicine and The Woman’s Hospital of Texas, Houston, Texas USA.

Address correspondence and reprint requests to Mahesh K. Shetty, MD, FRCR, Department of Radiology, Baylor College of Medicine and The Woman’s Hospital of Texas, 7600 Fannin St, Houston, TX 77054.

Objective. To evaluate the role of combined mammographic and sonographic imaging in patients with palpable abnormalities of the breast. Methods. Four hundred eleven consecutive cases of palpable abnormalities of the breast underwent combined mammographic and sonographic evaluation. Patients who did not undergo biopsy had imaging and clinical follow-up; the mean follow-up period was 28.9 months (range, 24–33 months). Results. One hundred sixty-five (40.1%) of 411 palpable abnormalities had a benign assessment; 97 (58.7%) of the 165 benign lesions were visible on both mammography and sonography; 66 (40%) of 165 benign lesions were mammographically occult and identified at sonographic evaluation. In 60 (14.6%) of the 411 cases, imaging evaluation resulted in a suspicious assessment; 49 (81.7%) of the 60 lesions categorized as suspicious underwent biopsy; 14 (28.5%) of 49 lesions were histologically proved to be carcinoma. Nineteen (31.6%) of the 60 lesions categorized as suspicious were mammographically occult and identified only on sonography; 14 (73.7%) of these 19 lesions underwent biopsy; 12 (63.1%) of 19 were benign, and 2 (10.5%) were malignant. One hundred eighty-six (45.2%) of the 411 palpable abnormalities had negative imaging assessment findings; 12 patients with negative imaging findings underwent biopsy, and all had benign findings. The sensitivity (14 of 14) and negative predictive value (186 of 186) for a combined mammographic and sonographic assessment were 100%; the specificity was 80.1% (186 of 232). Conclusions. Cancer was diagnosed in 14 (3.4 %) of 411 women who underwent combined imaging for palpable abnormalities of the breast. Combined mammographic and sonographic assessment was shown to be very helpful in identifying benign as well as malignant lesions causing palpable abnormalities of the breast.

Key Words: biopsy • breast • mammography • palpable lumps • sonography

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