Title: Role of B Mode in Evaluating Malignant Breast Masses

Authors: Dr Neethu Thomas, Dr Sajitha K, Dr Josey Verghese T

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.165

Abstract

Background: Breast cancer now represents the most common female malignancy in developing and developed world, and is the second leading cause of cancer death among women. USG is an ideal imaging modality due to its cost effectiveness and no ionizing radiation. Sonography has proved a useful adjunct to mammography, offering heightened discrimination of palpable lesions, notably in the more radiodense premenopausal breast. Accurate differentiation between benign and malignant breast nodules could result in improved care and reduction of patient discomfort, morbidity and health care cost. The purpose of the study is to help in establishing the role of sonography in differentiating malignant and benign breast lumps.

Aim: 1. To determine whether real-time B-Mode ultrasound is reliable in differentiating benign from malignant breast nodules.

  1. Compare and correlate the ultrasound findings with biopsy results.
  2. Assess the risk of malignancy for each type of ultrasound features in breast nodules.

Materials and Methods: This is an observational study with diagnostic test evaluation. Study was conducted at Dept of Radiodiagnosis in our hospital, a tertiary care centre with advanced services and one of the major referral centres in central Kerala. Breast ultrasound studies were performed for 64 women. Confirmation of ultrasound results was made by histopathology done by pathologist. Later the tissue diagnosis results were correlated with sonological findings by statistical analysis.

Results: In our study sonography showed a sensitivity of 95.3%, specificity of 85.7% and PPV of 93.2%. The accuracy of sonological evaluation was 92.2% with NPV of 90%.

Conclusion: Our study shows that a combination of B-Mode and Doppler ultrasound should continued to be used as an adjunct to mammography. The value is greatest when mammographic findings are indeterminate and the decision to biopsy or follow-up can be enhanced by the addition of ultrasound.

Keywords: Ultrasound scan, malignancy, benign.

References

  1. Center for disease control and prevention. Cancer prevention and control. [Online].;2014 [cited 2014 September 2. Available from: http:// www. cdc.gov/ cancer/ dcpc/data/women.htm
  2. Bagchi S. Breast cancer rises in India. CMAJ. 2008 Jul 1 ;179(1):27
  3. Chala LF, de Barros N . Breast evaluation and imaging methods. Radiologia Brasileira.2007 ;40 (1): 4-7.
  4. Stavros AT . Breast Ultrasound. 1st ed.: Lippincott Williams & Wilkins.; 2004
  5. Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions.Radiology. 1995 Jul;196(l):123-34
  6. Schelling M, Gnirs J, Braun M, Busch R, Maurer S, Kuhn W, Schneider KT, Graeff H. Optimized differential diagnosis of breast lesions by combined B-mode and color Doppler sonography. Ultrasound Obstet Gynecol. 1997 Jul;10(l):48-53
  7. Fornage BD, Andry E, Lorrigan JG. Fibroadenoma of the breast: sonographic appearance. Radiology 1989; 172:671-675
  8. Guita Rahbar, MD et al. Benign versus Malignant Solid Breast Masses: US Differentiation. Radiology.  1999;213: 889-894:
  9. Tohno E, Cosgrove DO, Sloane J. Ultrasound diagnosis of breast disease. First Edition. Churchill Livingstone.  Edinburgh, London, Madrid, Melbourne, New York/Tokyo. 1994; 23-70
  10. Gokhale S. Ultrasound characterization of breast masses. Indian J Radiol Imaging 2009;19:242-7
  11. Buderer, N. M. F., Statistical Methodology: I. Incorporating the Prevalence of Disease into the Sample Size Calculation for Sensitivity and Specificity. Academic Emergency Medicine, 1996; 3: 895-900
  12. Parikh R, Mathai A, Parikh S, Sekhar GC, Thomas R. Understanding andusing sensitivity, specificity and predictive values. Indian J Ophthalmol.2008;56:45-50 32.
  13. Costantini M, Belli P, Lombardi R, Franceschini G, Mule A, BonomoL Characterization of   solid       breast      Journal   of   Ultrasound   inMedicine.2006; 25: 649-659
  14. Berg WA, Birdwell RL, Gombos EC, Wang S, Parkinson BT, Raza S, Green GE, Kennedy A, Kettler MD. Diagnostic Imaging Breast. 1st Edition.2006;Arnirsys, Salt Lake City, Utah

Corresponding Author

Dr Sajitha K

Associate Professor, Govt. Medical College, Kottayam, Kerala

Email: This email address is being protected from spambots. You need JavaScript enabled to view it. Phone: 9447596346