Abstract

Radiological and Clinical Evaluation of Breast Lesions with Histopathological Correlation: A Prospective Study in a Tertiary Care Centre

Introduction: Breast cancer is a global problem. The incidence of breast cancer is rising in developing countries. As of 2021, breast cancer accounting for 12% of all new annual cancer cases worldwide, according to the World Health Organisation (WHO). Early diagnostic workup and intervention can significantly alter the course of the disease in favour of decreasing morbidity and mortality. Aims and objectives: To highlight the role of the combined modality approach (Full-Field Digital Mammography, Digital Breast Tomosynthesis, Sonomammography) in diagnosing breast lesions in the interpretation of Breast Imaging Reporting and Data system (BI-RADS) score both in diagnostic and screening settings. To diagnose early occult malignant lesions in both screening and diagnostic mammography and also to differentiate malignant lesions from benign pathologies. Settings and Design: A prospective longitudinal study was conducted from January 2019 to September 2019 (9 months) in the Department of Radio-diagnosis, Andhra Medical College, King George Hospital, Visakhapatnam, India using a Digital Mammography machine which was followed by Sonomammography. Materials and Methods: 880 women who presented to the department of Radiodiagnosis for screening mammography without symptoms and diagnostic mammography with various symptoms were evaluated with Full-Field Digital Mammography (FFDM), Sonomammography/Ultrasonography (USG), and Digital Breast Tomosynthesis (DBT) when indicated. Clinical findings, imaging findings based on BI-RADS, and histopathological findings were correlated and conclusions were drawn for the combined approach in our study. Variables: Age, Family history, Breast tenderness, Palpable abnormality/Lump, Nipple discharge. Results: A total of 880 women were enrolled in the study. The majority came for screening mammography and was in the age group of 40 to 49 years. Out of 880 examined 293 (33.3%) were diagnosed as benign and 45(5.5%) as malignant lesions, and diagnostic accuracy for BI-RADS 4, 5, and BI-RADS3 (upgraded) was found to be 92.85% through this combined modality approach when correlated with histopathological examination. Conclusion: Combination of FFDM, DBT, and USG/Sonomammography significantly increased sensitivity (92%), specificity (100%), positive predictive value (100%) and decreased false-positive rates and also increased the diagnostic confidence compared to the individual modality. This combined modality approach is beneficial in significantly decreasing the callbacks and unnecessary surgical interventions in selective cases. Recommendations: The ACR (American College of Radiology) and SBI (Society of Breast Imaging) recommend that women start getting annual mammograms at age 40 and continue as long as they are in good health.

• Full-Text
• PDF