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Indian Journal of Surgery
Medknow Publications on behalf of Association of Surgeons of India
ISSN: 0972-2068
Vol. 64, Num. 6, 2002, pp. 499-501

Indian Journal of Surgery, Vol. 64, No. 6, Nov - Dec. 2002, pp. 499-501

Role of Ultrasonography in the Differential Diagnosis of Palpable Breast Lump

Tariq Mansoor, Armeen Ahmad, Syed Hasan Harris, Ahmad

The Department of Surgery & Surgery & Radiodiagnosis, J. N. Medical College, Aligarh Muslim University, Aligarh (U.P.) - 202001
Address for correspondence: Dr Tariq Mansoor, Hafeez Manzil, Marris Road, Aligarh UP - 202001 Email: hasanharris@yahoo.com

Paper received: April 2002
Paper accepted: November 20020

Code Number: is02004

Abstract

One hundred cases of palpable breast masses were examined by ultrasonography (USG) and diagnosis confirmed by fine needle aspiration cytology (FNAC) and histopathology The ultrasound detected the presence of breast masses in 86 cases. False negative results were noted in 28% of cases. There were 44 solid and 42 cystic masses. The maximum number of benign lesions were present in the age group of 21-30 years and malignant lesions were maximally within the age group of 41-50 years. The diagnostic accuracy of ultrasound in carcinoma of the breast was 57.14% whereas that for fibroadenoma it was as high as 81.81%. For cystic masses the USG had a higher accuracy rate of 90.90%. The sensitivity of ultrasound on all breast masses was 86%.

Key words: Breast, lump, ultrasound

INTRODUCTION

The breast is the commonest site for development of cancer in the female and accounts for around 1/5 of all malignancies in this sex. Wild and Reid1 showed that masses in the breast could be visualized by ultrasonography. In the past few years ultrasonography of the breast for evaluation of radiologically dense breasts or cysts has been become the first line of investigation.2 The most important clinical use of an ultrasound imaging is its ability to differentiate between solid and cystic masses. The accuracy rate in this endeavor is 96-100% which is much higher than that of mammography or of clinical examination. Carcinoma of the breast continues to be a major cause of morbidity and mortality worldwide. The present article deals with 100 cases of palpable breast masses evaluated by ultrasonography at our institution and confirmed by other modalities like FNAC and histopathology.

MATERIAL & METHODS

Ultrasonographic evaluation of 100 palpable female breast masses was done and diagnosis made over a 2½ year period between August 1998 and February 2001. FNAC or histopathology of the operated specimen (whichever was done in the respective case) confirmed the diagnosis made by ultrasonography. All the cases were evaluated with Logic 500 Proserver having a linear multifrequency with a 6-9 MHz probe. A water bag was used for examination of all the breast lesions. Masses were viewed in both longitudinal and transverse plane employing low and high gain settings for the same transducer position. Each breast was examined by quadrant in survey search pattern. The ultrasound criterion for diagnosis was delineation or non-delineation of the breast masses. If the mass was delineated, its shape was described as circumscribed or non-circumscribed. Both benign and malignant lesions were found between each of the above categories. To determine the accuracy of ultrasonography in the present study the sonographic diagnosis was classified as correct, false positive, false negative or incorrect. Confirmation of the diagnosis reached at ultrasonography was made by FNAC or histopathology.

RESULTS

Out of 100 female breast masses positive scan was seen in 86 whereas 14 cases had a negative scan. These 14 cases not detected by an ultrasound proved to be carcinoma of the breast in 8 cases and fibroadenoma, tuberculosis and haematoma of the breast in two cases each. The maximum number of patients in our study were in the age group of 21 - 30 years followed by 41 - 50 age group. These two groups also represent the maximum patients with benign and malignant masses respectively. Forty-four breast masses were solid (44%) and (42%) cystic. Well-circumscribed masses were mostly benign (18 out of 20 cases) and poorly circumscribed were largely malignant (18 out of 24 cases). The accuracy of ultrasound in the detection of solid breast mass was 64.28% but for carcinoma of the breast alone was 57.14%. The cystic masses of the breast were more readily and correctly diagnosed by ultrasonography, the accuracy being 90.9% (Table 1). False negative cases for solid and cystic masses were 21.42% and 4.54% respectively (Table 2). The overall sensitivity of ultrasound in the detection of palpable breast masses was 86%.

DISCUSSION

Ultrasonography of the breast is useful in differentiating cystic from solid masses.3,4 In our study carcinoma of the breast was proved histologically in 28 cases, out of which 16 were correctly diagnosed by the ultrasound (57.14%). This diagnostic accuracy was found to be better as compared to the study by Kopans et al5 (52.60%). On the contrary Peere et al4 reported a very high sensitivity of ultrasound in breast carcinoma detection (96.6%). The low sensitivity detected in our study could be attributed to the very small size of the mass or its presence in a fatty breast. Out of the 16 cases diagnosed by USG in our study 14 were poorly circumscribed irregular hypoechoeic masses with jagged edges. In the study by Durfee et al6 97% of the cancers were hypoechoeic. Benign lesions of the breast were more readily diagnosed by the ultrasound than malignant lesions. Sensitivity of ultrasound in the diagnosis of fibroadenoma of the breast was 81.8% (19 out of 22 cases). Texidor and Kazam7 and Lee8 reported a lower accuracy rate of 70.6% and 74.5% respectively. The diagnosis of cystic masses by ultrasound had a higher accuracy rate of 90.9% which is in accordance with the findings of Fleischner et al9 and Lee et al8 (95.4%). Out of the 100 cases in our study 86 were detected by the ultrasound for the presence of breast masses giving a sensitivity of 86%. This is in close conformity with the results reported by Rubin et al10 and Fleischner et al.9 The sensitivity in their studies was 91% and 84% respectively.

CONCLUSION

Real time sonography is a simple, time saving and useful tool for examining breast masses. Ultrasonography has made a useful contribution in the evaluation of breast although it has its own limitations. It has a limited role in the early detection of breast cancer and it has not been established in screening though more and more work is being done for its role in screening breast carcinoma. Ultrasound of the breast has a definite role in the evaluation of the breast masses especially in the differentiation of a solid from a cystic lesion.

REFERENCES

  1. Wild J, Reid A. Echographic visualization of lesions of the living intact human breast. Cancer Research 1954; 14: 277 - 283.
  2. Biedermann KJ, Tuma J. Ultrasound Mammography. Schweiz Rundsch Med Prax 2001; 90: 767-772.
  3. Jachson VP, Reynolds HE, Hawes DR. Sonography of the breast. Semin ultrasound CTMR 1996; 17: 460-475.
  4. Perre CL, Koot VC, de Hooge P. The value of ultrasound in the evaluation of palpable breast tumors. Eur J Oncol 1995; 50: 165-167.
  5. Kopans DB, Meyer JE. Lindfors KK. Whole breast ultrasound imaging. Radiology 1985; 157: 505 _7.
  6. Durfee SM, Selland DL, Smith DN, et al. Sonographic evaluation of clinically palpable breast cancers invisible on mammography. Breast J 2000; 6: 247-251.
  7. Texidor HS, Kazam E. Combined mammographic-sonographic evaluation of breast masses. AJR 1977;128: 409 - 417.
  8. Lee CJ, awauchi A, Mastsui A. Ultrasonographic examination of the breast. John Wiley & Sone Ltd. 1983.
  9. . Fleischer AC, Muhlataler CA, Reynolds VH. Palpable breast masses: evaluation by high frequency hand held real time sonography and xeromammography. Radiology 1983; 148: 813-7.
  10. Rubin E, Miller VE, Berland LL. Hand held real time breast sonography. AJR. 1985; 144: 623 - 627.

Copyright 2002 - Indian Journal of Surgery. Also available online at http://www.indianjsurg.com


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