International Journal of Advanced and Integrated Medical Sciences

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Role of mammography and ultrasonography in the evaluationof suspected breast lesions in Rohilkhand Medical College andHospital, Bareilly, Uttar Pradesh, India
  IJAIMS
ORIGINAL ARTICLE
Role of mammography and ultrasonography in the evaluationof suspected breast lesions in Rohilkhand Medical College andHospital, Bareilly, Uttar Pradesh, India
Himani Sharma1, Himanshu Pandey2, Lalit Kumar3, Pramod Kumar4, Divya Bajpai5, Vibhuti Goyal6
1-4Department of Radiodiagnosis, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India, 5,6Department ofPathology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
Corresponding Author:
Himanshu Pandey,Department of Radiodiagnosis,Rohilkhand Medical College andHospital, Bareilly,Uttar Pradesh, India.
E-mail: drhphp@gmail.com
Received: 02-06-2018
Accepted: 10-06-2018
Published: 16-06-2018
 
ABSTRACT
Introduction: Breast lesions are common presenting complaints in females in the surgicaloutpatient department. Breast lesions are broadly classified as benign or malignant.It generally affects the females of reproductive age group. Mammography is used asscreening modality as well as an efficient technique in evaluation of clinically suspectedbreast lesions.
Aim: The aim of the study was to assess the role of mammography andsonomammography followed by histopathological/cytological evaluation of the lesions inthe assessment of breast lesions and to assign the Breast Imaging Reporting and Data System(BIRADS) category. The aim of our study was to determine the efficacy of mammographyand sonomammography in the evaluation of women presenting with breast lesions.
Materials and methods: We conducted a prospective study on 72 females from January2018 to May 2018 in the Department of Radiodiagnosis in Rohilkhand Medical College.Mammography and sonomammography characteristics of breast lesions which help todifferentiate benign from malignant lesions were assessed. Fine-needle aspiration cytology(FNAC)/biopsy was carried out.
Results: Mammographic and sonomammographicevaluation of 72 females was done. The lesions were classified according to BIRADScategories based on their mammographic and ultrasonographic (USG) findings. Patientswere aged from 8 to 60 years with a mean age of 32 years. It was found that most benignlesions were seen in younger age group while malignant lesions were seen in older agegroup. The mean age of occurrence of breast lesions was about 20-40 years. The lesionswere classified according to BIRADS. The FNAC showed the highest incidence offibroadenoma (44%) followed by benign cysts (31%).
Conclusion: Classification of lesionsand assigning categories in accordance with BIRADS help to improve the management.Mammography is better in detection of microcalcifications and early occult malignancies.Sonomammography is better in detecting cystic lesions and has an added advantage inguiding FNAC and biopsies. Combination of mammographic and USG evaluation ofbreast masses was found to be more accurate than either method alone.
KEY WORDS: American College of Radiology, Breast Imaging Reporting and DataSystem, Breast masses, fine-needle aspiration cytology, malignant breast lesions,mammography, sonomammography
How to cite this article: Sharma H,Pandey H, Kumar L, Kumar P,Bajpai D, Goyal V. Role ofmammography and ultrasonographyin the evaluation of suspected breastlesions in Rohilkhand MedicalCollege and Hospital, Bareilly, UttarPradesh, India. Int J Adv Integ MedSci 2018;3(2):8-11.
Source of Support: Nil,
Conflicts of Interest: None declared.
 
 

INTRODUCTION

Breast density is influenced by stage of menstrual cycle, parity,obesity, age, and ethnicity. Breast cancer is one of the mostcommon causes of cancer deaths today, coming fifth after lung,stomach, liver, and colon cancers.[1] It is the most common causeof death in women.[2]

 
Harmonic imaging and real-time compounding have shown toimprove image resolution and lesion characterization.[3,4]

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Sharma, et al. Mammography and breast lesions

Harmonic imaging and real-time compounding have shown toimprove image resolution and lesion characterization.[3,4]

Young women tend to have dense breasts and theirmammograms are there is difficulty interpretation. Thereis an inverse relationship between mammographic breastdensity and patient's age.[5] The sensitivity of mammographyin detection of breast cancer in the screening ranges from ~83to 95%.[6]

High-resolution sonography is a useful modality that helps toevaluate breast lesions additionally and also helps to characterizea mammographically non-detectable palpable abnormality indense breast.[7]

However, it is as low as 30-48% in patients with radiologicallydense and glandular breast.[8]

In our study, an attempt is made to evaluate breast massesusing mammography and ultrasonomammography withhistopathological/cytological correlation to describe variouslesions and differentiate benign from malignant ones.

Indications for breast ultrasound are as follows:
  • Differentiation of mammographic lesions Breast ImagingReporting and Data System (BIRADS) 0-5;
  • Palpable lesions: Differentiate between cystic/solid andbenign/malignant;
  • Pre-operative planning for breast conservation surgery ormastectomy: Tumor size, localization, multicentricity, andmultifocality;
  • Follow-up measurements of the lesion in patients underneoadjuvant chemotherapy;
  • Guidance for interventions;
  • Additional breast scanning in mammographically densebreasts (American College of Radiology category 3-4));
  • Young women < 40 years, in pregnant females, and lactatingfemales;
  • Screening in high-risk patients.[9]

MATERIALS AND METHODS

We conducted a prospective study on 72 females from January2018 to May 2018 in the Department of Radiodiagnosis inRohilkhand Medical College. Characteristics of mammographyand sonomammography of breast lesions which help todifferentiate benign from malignant lesions were assessed.

The exclusion criteria were incomplete diagnostic assessment,the lesions in which pathology evaluation was not performed,and lack of follow-up.[5]
  • BIRADS 0: Further imaging is required. Specialmammographic views (compression and magnification),ultrasound
  • BIRADS I: Negative
  • BIRADS II: Benign findings (cyst, fibroadenoma, lipoma,and secretory calcifications)
  • BIRADS III: Probably benign, short-interval follow-upsuggested (6 months)
  • BIRADS IV: Suspicious abnormality
  • BIRADS IVa: Low level of suspicion for malignancy
  • BIRADS IVb: Intermediate suspicion for malignancy
  • BIRADS IVc: Moderate suspicion for malignancy
  • BIRADS V: Mammographic appearance highly suggestiveof malignancy (spiculated margins, pleomorphiccalcification, etc.)
  • BIRADS VI: Known biopsy-proven malignancy.

 

RESULTS

Mammographic and sonomammographic evaluation of72 females was done. The lesions were classified accordingto BIRADS categories [Table 1]. Patients were aged from 8 to60 years with a mean age of 32 years. It was found that mostbenign lesions were seen in younger age group, while malignantlesions were seen in older age group.[10] The mean age ofoccurrence of breast lesions was about 20-40 years [Figure 1].The lesions were classified according to BIRADS. The FNACof the lesions was done and it was found that the incidence offibroadenoma was highest (44%) among all the breast lesionsfollowed by benign cysts (31%) [Graph 1].

DISCUSSION

In the present study, the youngest patient with malignancy was30 years of age, whereas the oldest patient with benign lesionwas of 53 years. The sensitivity of mammography is low incase of benign lesion, especially in dense breasts and for verysmall lesions. Sensitivity and specificity of mammographyfor malignant lesions were found to be high becausemicrocalcifications were better detected.[11] Sonography wasfound to be more helpful for characterization and differentiationof cystic from solid lesions. The specificity of USG in detectingmalignant lesions was less because microcalcifications were notwell seen on USG. These observations are similar to those ofPrasad and Houserkova[12] and Texidor and Kazam.[13]

Irregular shape, high density, spiculated/indistinct margins,and microcalcifications were features of malignancy onmammography; heterogeneously hypoechoic echotexture,microlobulations, taller than wider lesions, internal vascularity,and features such as skin retraction and nipple thickening wereseen in malignant lesions on sonography. Oval shape, wider thantall lesion, and anechoic or homogenously hypoechoic lesionfavor benign nature on sonography. Characteristic shapes ofbenign and malignant lesions were similar to the description bySickles.[14] The calcification features are similar to many of thesimilar studies.[12,14]

Role of mammography and ultrasonography in the evaluation of suspected breast lesions in Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
BIRADS: Breast imaging reporting and data system

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Sharma, et al. Mammography and breast lesions

Role of mammography and ultrasonography in the evaluation of suspected breast lesions in Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
Figure 1: (a-e) Middle-aged female presented with lump in the left breast. The above images depict malignant lesions (from left to right).(a) Mammogram right breast mediolateral oblique view showing two high-density mass-like lesions, one of them is large round to ovallobulated, well-defined margins and another one shows ill-defined lesion with obscured margins associated with nipple retraction and skinthickening. (b) USG high-frequency image showing irregular-shaped hypoechoic lesion with indistinct margins with posterior shadowing.Focal calcification is seen separately. (c) Enlarged lymph nodes with fatty hila. (d) Few hypoechoic lesions in the right lobe of liversuggestive of metastasis. (e) Histopathology report-intraductal carcinoma

Role of mammography and ultrasonography in the evaluation of suspected breast lesions in Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
Graph 1: (a) Pie chart depicting the morphology of calcification. (b) Bar graph showing the pattern of fibroglandular breast tissue accordingto age groups. (c) Bar graph illustrating margin of lesions. (D) Pie chart depicting histopathological diagnosis

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Sharma, et al. Mammography and breast lesions

CONCLUSION

Combination of mammography and USG in the evaluation ofbreast masses was more accurate than either modality alone.Sonomammography is better in detecting purely cystic lesions.The added advantages of USG include wide availability, lackof ionizing radiation, and assessment of vascularity in thelesion. Mammography is better in detecting microcalcificationsand detecting early occult malignancies.[11] The sensitivityof mammography is less in case of denser breasts. Thedisadvantages of ultrasound include operator dependence. Selfbreastexamination and breast screening must be advised for theearly detection of breast lesions and for further management.[15]

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