The Value of Adding Ultrasound in the Diagnosis of Breast Mass

Year 2015, Volume: 5 Issue: 3, 42 - 46, 14.10.2015

Erdal Uysal , Mesut Sipahi Hasan Bakır Mehmet Dokur A. Mehmet İkidağ O. Ahmet Gurer Başar Aksoy M. Fatih Yüzbaşıoğlu

Abstract

Background: Mammography has been used widely for breast cancer screening. However, the false-negative rate of mammography is 35%. Breast ultrasonography (USG) is the most common method used for additional screening. Performing routine breast ultrasonography (USG) with mammography is still a matter of debate. In our study, it has been aimed to determine the value of adding breast ultrasonography (USG) on the suspicious breast masses.

Material and Methods: In our study, 121 breast lesions were evaluated in 104 patients. Files and images of patients were analyzed retrospectively. Patients who underwent mammography and ultrasound imaging were included in the study. Lesions were categorized in accordance with the Breast Imaging Reporting and Data System (BIRADS) classification. Patients were divided into two groups (under and above 45 years of age), and sensitivity and specificity rates of mammography and USG were compared.

Results: Mammography of 27 patients with malignant masses was reported as BIRADS 1, 2 and 3, respectively and nothing was mentioned about malignant masses. Breast ultrasonography (USG) was not able to detect the malignant masses in 9 patients. Three patients were detected as false-positive in the breast ultrasonography (USG). patients were divided into two groups as; those older than 45 and younger than 45, were divided into two groups; it has been observed that patients who are under 45 are more sensitive, and mammography is more specific for the other group, who are above 45 years old (p<0.05). There was a significant difference between the groups that have Type 1 and 2 breast pattern and Type 4 breast pattern in terms of mammographic sensitivity rates (p<0.05).

Conclusion: Breast ultrasound is more sensitive in demonstrating malignant breast masses. Mammography is more specific for patients above 45 years of age. Breast density is the most important factor in determining the sensitivity of mammography. However, sensitivity and specificity will increase with additional screening methods such as breast ultrasonography (USG) and MRI. 

Keywords

Mammography; Ultrasonography; Breast cancer

MEME KİTLELERİNİN TANISINDA ULTRASONOGRAFİ EKLENMESİNİN DEĞERİ

Abstract

Amaç: Mamografi meme kanseri taramasında yaygın olarak kullanılmasına ragmen yanlış negatiflik oranı %35 dir. Meme Ultrosonografisi en sık kullanılan ek tarama metodudur. Mamografi ile birlikte rutin meme usg’si yapılması halen tartışmalıdır. Çalışmamızda şüpheli meme kitlelerinde meme USG eklenmesinin değerini belirlemek amaçlanmıştır.

Gereç ve Yöntemler: Çalışmamıza 104 hastadaki toplam 121 meme lezyonu değerlendirildi. Mamografi ve ultrasonography (USG) görüntüleme yapılan hastalar çalışmaya dahil edildi. Lezyonlar Breast Imaging Reporting and Data System (BIRADS) sınıflamasına gore categorize edildi. Hastalar 45 yaş altı ve üstü olarak iki gruba ayrılarak mamografi ve ultrasonography (USG)’nin sensivite ve spesifite oranları karşılaştırıldı.

Bulgular: Malign kitlesi olan 27 hastanın mamografileri BRIADS 1,2 ve 3 olarak raporlandı. Malign kitlelerden bahsedilmedi. Meme ultrasonography (USG) 9 hastada malignite taşıyan kitleyi saptayamadı. Meme ultrasonography (USG) ile 3 hastada yanlış pozitiflik saptandı. Hastalar 45 yaş altı ve üstü olarak iki gruba ayrıldığında meme ultrasonography (USG)’sinin 45 yaş altı grupta daha duyarlı olduğu, mamografininise 45 yaş üstünde daha spesifik olduğu bulundu (p<0,05) Tip 1 ve 2 meme paternine sahip grup ile tip 4 meme paternine sahip gruplararasında mamografinin duyarlılık oranlarında istatistiksel anlamlılık saptandı (p<0,05).

Sonuç: Meme ultrasonography (USG)’si memedeki malign kitleleri göstermede daha duyarlıdır. 45 yaşın üzerindeki hastalarda mamografi daha spesifiktir. Meme yoğunluğu mamografinin duyarlılığını belirlemede önemli etkendir. Ancak meme ultrasonography (USG) ve MRI ile ek görüntülemelerde duyarlılık ve spesifitede artış olacaktır. 

Keywords

Mamografi, Ultrasonografi, Meme kanseri

References

• Tan KP, Mohamad Azlan Z, Rumaisa MP, Siti Aisyah Murni MR, Radhika S, Nurismah MI, Norlia A, Zulfiqar MA. The comparative accuracy of ultrasound and mammography in the detection of breast cancer. Med J Malaysia. 2014; 69(2):79-85.
• Basara I, Orguc S, Coskun T. Dıagnostıc values of mammography, ultrasonography and dynamıc enhanced magnetıc resonance ımagıng in breast lesıons. TheJournal of BreastHealth 2011: 7(2): 118-126.
• Berg WA, Gutierrez L, NessAiver MS, Carter WB, Bhargavan M, Lewis RS, Ioffe OB.Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer.Radiology.2004 ;233(3):830-49.
• Strobel K, Schrading S, Hansen NL, Barabasch A, Kuhl CK. Assessment of BI-RADS Category 4 Lesions Detected with Screening Mammography and Screening US: Utility of MR Imaging.Radiology.2015;274(2):343-51.
• Nothacker M, Duda V, Hahn M, Warm M, Degenhardt F, Madjar H, Weinbrenner S, Albert US. Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review. BMC Cancer. 2009; 20;9:335.
• McCavert M, O’Donnell ME, Aroori S, Badger SA, Sharif MA, Crothers JG, Spence RA. Ultrasound is a useful adjunct to mammography in the assessment of breast tumours in all patients. Int J ClinPract. 2009; 63(11):1589-94.
• Gartlehner G, Thaler K, Chapman A, Kaminski- Hartenthaler A, Berzaczy D, Van Noord MG, Helbich TH.Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk.Cochrane Database SystRev. 2013; 30;4:CD009632.
• Hille H, Vetter M, Hackelöer BJ.Re-evaluating the role of breast ultrasound in current diagnostics of malignant breast lesions.UltraschallMed. 2004; 25(6):411-7.
• Osako T, Iwase T, Takahashi K, Iijima K, Miyagi Y, Nishimura S, Tada K, Makita M, Akiyama F, Sakamoto G, Kasumi F. Diagnostic mammography and ultrasonography for palpable and nonpalpable breast cancer in women aged 30 to 39 years. BreastCancer. 2007;14(3):255-9.
• Devolli-Disha E, Manxhuka-Kërliu S, Ymeri H, Kutllovci A.Comparative accuracy of mammography and ultrasound in women with breast symptoms according to age and breast density. Bosn J Basic MedSci. 2009; 9(2):131-6.
• Berg W. Rationale for a trial of screening breast ultrasound: American College of Radiology Imaging Network. AJR 2003;180 (5):1225-1228.
• Kolb TM, Lichy J, Newhouse JH. Comparison of the Performance of Screening Mammography, Physical Examination, and Breast US andEvaluation of Factors that Influence Them: An Analysis of 27,825 Patient Evaluations. Radiology 2002; 225(1): 167-75.
• Gartlehner G, Thaler KJ, Chapman A, Kaminski A, Berzaczy D, Van Noord MG, Helbich TH. Adjunct ultrasonography for breast cancer screening in women at average risk: a systematic review. Int J EvidBasedHealthc.2013 ;11(2):87-93.
• Chan SW, Cheung PS, Chan S, Lau SS, Wong TT, Ma M, Wong A, Law YC. Benefit of ultrasonography in the detection of clinically and mammographically occult breast cancer. World J Surg. 2008; 32(12):2593-8.