DIAGNOSTIC ACCURACY OF ULTRASONOGRAPHY COMPARED WITH MAMMOGRAPHY IN THE EVALUATION OF PALPABLE BREAST LUMPS: A CROSS-SECTIONAL STUDY FROM A TERTIARY CARE TEACHING HOSPITAL
DOI:
https://doi.org/10.48047/p2v2gv02Keywords:
Breast neoplasms, Ultrasonography, mammary, Mammography, Diagnostic accuracy, Sensitivity and specificityAbstract
Background: Palpable breast lumps are a common presenting complaint among women attending outpatient services in South India, and accurate, timely triage into benign and malignant categories is essential for appropriate management. Ultrasonography (USG) and mammography are the two principal imaging modalities available at most tertiary centres, but their comparative performance in a relatively young, dense-breasted South Indian population is incompletely characterized. Objective: To determine and compare the diagnostic accuracy of high-resolution USG and mammography, individually and in combination, against histopathology as the reference standard, in women presenting with palpable breast lumps. Methods: This hospital-based cross-sectional diagnostic accuracy study was conducted in the Department of Radiodiagnosis, tertiary care teaching hospital, India, during sixs months. Consecutive women with a palpable breast lump underwent high-resolution USG and mammography, each interpreted with the Breast Imaging-Reporting and Data System (BI-RADS), followed by histopathological confirmation. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and accuracy were computed for each index test; overall correct classification was compared using the McNemar test (p<0.05). Results: Among 240 women (mean age 44.8 +/- 13.7 years; 72.5% premenopausal), histopathology confirmed malignancy in 85 (35.4%). USG achieved a sensitivity of 95.3%, specificity 83.9%, PPV 76.4%, NPV 97.0% and accuracy 87.9%, whereas mammography achieved a sensitivity of 89.4%, specificity 89.0%, PPV 81.7%, NPV 93.9% and accuracy 89.2%. Combined testing (either modality positive) raised sensitivity to 98.8% and NPV to 99.2% but reduced specificity to 76.1%. The McNemar comparison of overall correct classification showed no statistically significant difference between USG and mammography (discordant pairs b=20, c=23; p=0.76). Conclusion: In this young, dense-breasted South Indian cohort, USG was more sensitive and mammography more specific, with comparable overall accuracy. The two modalities are complementary; combined testing maximises sensitivity and NPV. USG is a valuable first-line and adjunct test for the evaluation of palpable breast lumps in South India.
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Kerlikowske K, Smith-Bindman R, Ljung BM, Grady D. Evaluation of abnormal mammography results and palpable breast abnormalities. Ann Intern Med. 2003;139(4):274-84. doi:10.7326/0003-4819-139-4-200308190-00010
Jan M, Mattoo JA, Salroo NA, Ahangar S. Triple assessment in the diagnosis of breast cancer in Kashmir. Indian J Surg. 2010;72(2):97-103. doi:10.1007/s12262-010-0030-7
Bilali M, Lagoudianakis EE, Peitsidis P, et al. The role of sonography in the diagnosis of cystic lesions of the breast. Eur J Gynaecol Oncol. 2009;30(5):506-8.
Sehgal CM, Weinstein SP, Arger PH, Conant EF. A review of breast ultrasound. J Mammary Gland Biol Neoplasia. 2006;11(2):113-23.
Lord SJ, Lei W, Craft P, et al. A systematic review of the effectiveness of magnetic resonance imaging as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer. 2007;43(13):1905-17. doi:10.1016/j.ejca.2007.06.007
Lehman CD, Blume JD, Weatherall P, et al. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer. 2005;103(9):1898-905. doi:10.1002/cncr.20971
Habib S, Maseeh-uz-Zaman, Hameed A, et al. Diagnostic accuracy of Tc-99m-MIBI for breast carcinoma in correlation with mammography and sonography. J Coll Physicians Surg Pak. 2009;19(10):622-6.
Dershaw DD. Status of mammography after the Digital Mammography Imaging Screening Trial: digital versus film. Breast J. 2006;12(2):99-102. doi:10.1111/j.1075-122X.2006.00216.x
Vinnicombe S, Pinto Pereira SM, McCormack VA, et al. Full-field digital versus screen-film mammography: comparison within the UK breast screening program and systematic review of published data. Radiology. 2009;251(2):347-58. doi:10.1148/radiol.2512081235
Cole E, Pisano ED, Brown M, et al. Diagnostic accuracy of Fischer Senoscan Digital Mammography versus screen-film mammography in a diagnostic mammography population. Acad Radiol. 2004;11(8):879-86. doi:10.1016/j.acra.2004.04.003
Varughese AA, Poothiode U, Manjula VD. Descriptive study on selected risk factors and histopathology of breast carcinoma in a tertiary care centre in Kerala, India with special reference to women under 40 years old. Asian Pac J Cancer Prev. 2015;16(1):181-4. doi:10.7314/apjcp.2015.16.1.181
Ganesh B, Talole SD, Dikshit R, Badwe RA, Dinshaw KA. Estimation of survival rates of breast cancer patients-a hospital-based study from Mumbai. Asian Pac J Cancer Prev. 2008;9(1):53-7.
Chunder N, Mandal S, Basu D, et al. Deletion mapping of chromosome 1 in early onset and late onset breast tumors-a comparative study in eastern India. Pathol Res Pract. 2003;199(5):313-21. doi:10.1078/0344-0338-00423
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