(Ultrasound Review) The role of combined mammographic and sonographic imaging in women with palpable lesions was recently evaluated in a study published in Journal of Ultrasound in Medicine. Radiologists at Baylor College of Medicine and the Woman’s Hospital of Texas, both in Houston, studied 388 patients with 411 palpable breast abnormalities.
Mammographic imaging included straight mediolateral views, and mediolateral-oblique/lateromedial-oblique and craniocaudal views. A radio-opaque marker was place at the site of the palpable lesion.
They determined that 40.1% of lesions were benign, and 58.7% of these benign lesions were shown on both imaging modalities, while 40% only were shown on ultrasound. There were 60 lesions that were considered suspicious. Biopsy was performed on 49 of these, and 14 were carcinomas.
"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)," they found. The malignancy rate for palpable lesions was 3.4 % in this study.
Biopsy was performed in twelve patients with negative imaging findings because of a high degree of clinical suggestion, but all were benign. The positive predictive value (PPV) for cancer of lesions with questionable findings was 23.3%, and the PPV for lesions undergoing biopsy was 28.5%.
"Sonography therefore is complementary to mammography in patients with palpable abnormalities; its superiority over mammography is in being able to show lesions obscured by dense breast tissue and in characterizing palpable lesions that are mammographically visible or occult," they reported.
The authors concluded, "combined use of mammography and sonography is appropriate in most instances to characterize palpable lesions and to avoid unnecessary interventions in those cases in which imaging findings are unequivocally benign." Also they determined that a negative finding on both mammographic and ultrasound imaging was highly specific and very reassuring.
Prospective evaluation of the value of combined mammographic and sonographic assessment in patients with palpable abnormalities of the breastShetty, M. et al.
Department of radiology, Baylor College of Medicine and the Woman’s Hospital of Texas, Houston
J Ultrasound Med 2003 March; 22:263-268
By Ultrasound Review
May 30, 2003
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