Role of high frequency ultrasonography in the evaluation of palpable breast masses in Chinese women: alternative to mammography?

Abstract

We prospectively assessed the accuracy of high resolution breast ultrasonography in the diagnosis of palpable breast masses in comparison to clinical palpation and x-ray mammography. Four hundred and eight Chinese women with palpable breast lumps had clinical assessment followed by ultrasonography of the breast, mammography (for women over 35 years), and fine needle aspiration cytology. Excisional biopsy or surgery was performed for suggestive lesions. The clinical, mammographic and ultrasound diagnoses were compared with the final pathologic diagnosis. In the determination of whether a lesion was malignant, the sensitivity, specificity, and positive predictive values were 97%, 97%, and 85%, respectively, for ultrasonography; 92%, 94%, and 84%, respectively, for mammography; and 88%, 92%, and 67%, respectively, for clinical evaluation. The specificity for combined clinical palpation and ultrasonography was higher (99%) than that for combined clinical palpation and mammography (96%). Addition of ultrasonography to combined clinical palpation and mammography increased specificity. Mammography in addition to combined clinical palpation and ultrasonography did not significantly improve the sensitivity, specificity, or positive predictive value. This limited usefulness raises the question as to whether it should be eliminated in the workup of a palpable mass in the average Chinese patient. Its main advantage is the detection of extended foci of carcinoma in situ related to a palpable mass, which often is undetected by ultrasonography.

Pilot Study of a Resource-Appropriate Strategy for Downstaging Breast Cancer in Rural Uganda

“…We attribute the higher CDR observed in our study to the higher incidence of breast cancer in Uganda (32.3 per 100,000) compared to India (20 per 100,000) and the inclusion of only symptomatic women in our study (23,24). We further demonstrate interpretive performance for PPV2 and 3 that are within the performance ranges published previously (2-96%) (25)(26)(27)(28). Our specificity was lower than in these studies (49-97%), which reflects the high proportion of women presenting with masses assessed as BI-RADS 3 (46%), and also the high proportion of young women presenting for evaluation.…”

Uma proposta de classificação ecográfica mamária

“…Tal como as sensibilidades, os valores preditivos negativos do Quadro 2 se revelaram também muito homogêneos, variando de 90,0 a 99,5%. Finalmente, a acurácia, que é definida como a proporção de acertos de um teste diagnóstico, teve os maiores valores nos trabalhos de Yang et al 16 (97,0%) e no nosso trabalho atual (95,1%). A utilização de uma padronização na descrição das lesões mamárias e de uma classificação ecográfica é importante, pois possibilita uma aná-lise das imagens de maneira mais objetiva e cria uma nomenclatura uniforme.…”

“…O valor preditivo positivo é a proporção de verdadeiros positivos entre todos os indivíduos com teste positivo, sendo que o nosso trabalho e o de Yang et al 16 apresentam os melhores resultados (Quadro 2). Os valores preditivos positivos dos ouQuadro 2 -Propriedades diagnósticas da ultra-sonografia mamária, por autor.…”

Comparison of Ultrasonography and Fine Needle Aspiration Cytology in the Diagnosis of Malignant Breast Lesions

“…The sensitivity has also been found to be dependent on the skill and experience of the aspirator [4]. Similarly a wide variation in the sensitivity of USG in the diagnosis of malignant breast lesion ranging from 67% to 97% has been reported [7,8]. These wide variations amongst different study could be due to different methods of case selections, different resolution power of ultrasound equipment used, and due to the fact that ultrasound is an operator dependent technique.…”