Role of Ultrasound as an Adjunct Modality to Mammography in the Diagnostic Evaluation of Breast Cancer

Abstract

Background: To determine the role of ultrasound
as an adjunct modality to mammography in
diagnosing breast cancer.
Methods: Total 100 patients of breast cancer were
recruited in this comparative study. These cases were
subjected to mammography. Ultrasound was then
performed as an adjunct modality while clinical and
mammographic results were available to the
radiologist evaluating the ultrasound scans. Patients
with positive findings were then followed for
histopathology findings obtained from excisional
biopsy or mastectomy specimen. The results of
histopathology were taken as gold standard.
Sensitivity and specificity of mammography and
adjunctive ultrasound was calculated by
constructing a 2 x 2 table taking histopathology as
gold standard. Statistical measures of accuracy,
sensitivity, specificity, positive predictive (PPV) and
negative predictive values (NPV) were calculated.
Results: Age distribution revealed, 68 patients
(68.0%) were < 40 years of age. Mean age of the
patients was 44.9 ±5.2 years. Distribution of cases by
presenting symptoms was as follows: breast lump 93
(93.0%), and breast pain 7 (7.0%) with nipple
discharge 10 (10.0%) and nipple retraction 8 (8.0%).
Family history of breast cancer was present in 37.0%.
Combined sensitivity of mammography and
adjunctive ultrasound was 94.67%, specificity
77.78%, diagnostic accuracy 85.54%, positive
predictive value 89.87%, negative predictive value
63.63% comparatively better than these modalities
alone.
Conclusion: Ultrasound can be considered as a
primary screening tool in younger population and as
an adjunct to mammography in elder women to
minimize the chances of missing diagnosis of breast
cancers.