PURPOSE: To determine whether sonography could help accurately distinguish benign solid breast nodules from indeterminate or malignant nodules and whether this distinction could be definite enough to obviate biopsy. MATERIALS AND METHODS: Seven hundred fifty sonographically solid breast nodules were prospectively classified as benign, indeterminate, or malignant. Benign nodules had no malignant characteristics and had either intense homogeneous hyperechogenicity or a thin echogenic pseudocapsule with an ellipsoid shape or fewer than four gentle lobulations. Sonographic classifications were compared with biopsy results. The sensitivity, specificity, and negative and positive predictive values of the classifications were calculated. RESULTS: Benign histologic features were found in 625 (83%) lesions; malignant histologic features, in 125 (17%). Of benign lesions, 424 had been prospectively classified as benign. Two lesions classified as benign were found to be malignant at biopsy. Thus, the classification s...

Solid breast nodules: use of sonography to distinguish between benign and malignant lesions.

With recent significant advances in ultrasound technology, the potential of high-resolution sonography to improve the sensitivity of cancer diagnosis in women with dense breasts has become a matter of interest for breast imagers. To determine how often physician-performed high-resolution sonography can detect nonpalpable breast cancers that are not revealed by mammography, 8,970 women with breast density grades 2 through 4 underwent high-resolution sonography as an adjunct to mammography. All sonographically detected, clinically and mammographically occult breast lesions that were not simple cysts were prospectively classified into benign, indeterminate, or malignant categories. Diagnoses were confirmed by ultrasound-guided fine-needle aspiration, core-needle biopsy, or surgical biopsy. In 8,103 women with normal findings at mammography and physical examination, 32 cancers and 330 benign lesions were detected in 273 patients with sonography only. Eight additional cancers were found in 867 patients with a malignant (n = 5) or a benign (n = 3) palpable or mammographically detected index lesion. The overall prevalence of cancers detected with screening sonography was 0.41%, and the proportion of sonographically detected cancers to the total number of nonpalpable cancers was 22%. The mean size of invasive cancers detected only by sonography was 9.1 mm, and was not statistically different from the mean size of invasive cancers detected by mammography. The sensitivity of prospective sonographic classification for malignancy was 100%, and the specificity was 31%. In conclusion, the use of high-resolution sonography as an adjunct to mammography in women with dense breasts may lead to detection of a significant number of otherwise occult cancers that are no different in size from nonpalpable mammographically detected cancers. Prospective classification of these lesions based on sonographic characteristics resulted in an acceptable benign-to-malignant biopsy rate of 6.3:1.

Clinically and mammographically occult breast lesions: Detection and classification with high-resolution sonography

The breast containing an augmentation implant presents a challenge to the mammographer and is often considered unsuitable for adequate mammographic evaluation. A modified positioning technique is described. By displacing the implant posteriorly against the chest wall and pulling breast tissue over and in front of the implant, marked improvement in compression and visualization of substantially more breast tissue is achieved. Over 250 patients with augmentation implants have been successfully studied with this modified compression technique. After review of 50 consecutive cases, two experienced mammographers confirmed a significant improvement in image quality, amount of breast tissue visualized, and overall benefit of the modified technique. Modified positioning for women with breast implants substantially improves both image quality and amount of breast tissue imaged.

/pdf/improved-imaging-of-the-augmented-breast-2x3tiswphy.pdf

Improved imaging of the augmented breast.

This prospective study, involving 1,000 women referred for routine mammography, compares the breast cancer detecting abilities of state-of-the-art mammography and sonography using an automated water-path scanner. Mammography was found to be the superior technique, detecting 62 (97%) of the 64 pathologically proven cancers, while sonography detected only 37 (58%). When considering those cancers most amenable to cure, mammography detected over 90% in all categories, but sonography detected only 48% of the cancers that had not yet spread to axillary lymph nodes, only 30% of the nonpalpable malignancies, and only 8% of the cancers smaller than 1 cm. These data indicate that sonography is not an acceptable substitute for mammography in the detection and diagnosis of breast cancer. The data further suggest that radiologists who wish to improve the cancer-detecting ability of their current breast imaging operation should upgrade their mammography to state-of-the-art status before adding an automated whole-breast...

Breast cancer detection with sonography and mammography: comparison using state-of-the-art equipment.

The Role of Ultrasound in Breast Cancer Screening. A Consensus Statement by the European Group for Breast Cancer Screening

The results of 1,029 ultrasound B-scan examinations of the breast using two automated water-path scanners were correlated with histopathology data in 278 patients who had undergone biopsy. Of the 1,029 patients, a subgroup of 709 patients had both ultrasound mammograms (USM) and radiographic mammograms (XRM) obtained. A sensitivity for breast cancer of 69% was found for USM and 74% for XRM on initial independent readings when there was no knowledge of clinical data. These are not statistically different using the McNemar test for paired comparisons. When the USM were reinterpreted with the knowledge of the patient's age, history, physical examination, and, when available, the XRM interpretation, the USM sensitivity for breast cancer was 79%.

Ultrasound mammography: a comparison with radiographic mammography.

The evaluation of 1,003 sonomammographic examinations on a predominantly symptomatic population using a prototype real-time dedicated breast scanner is presented. Interpretations were initially made by one of four experienced radiologists without knowledge of clinical data (i.e., symptoms, age, physical findings, or other imaging modality interpretations). A second interpretation was subsequently made with this information. Pathologic confirmation was available on 262 lesions, including 71 carcinomas and 191 benign biopsies. Of the carcinomas, 19 were smaller than 2.0 cm in diameter. The sensitivity of sonographic detection of breast cancer on initial readings was 0.76 and on second readings with clinical data was 0.85. The specificity for a benign reading on sonography was 0.80 on initial interpretation and 0.81 on the second interpretation.

https://www.ajronline.org/doi/pdfplus/10.2214/ajr.139.5.905

Clinical experience with a prototype real-time dedicated breast scanner.

Ultrasound examinations were performed on 25 women with augmented breasts using whole-breast water-path scanning. In these patients, ultrasound imaged carcinoma, benign lesions, and fibrous capsule formation; these were confirmed by surgery. In addition, it was noted that certain prostheses appeared to be displaced posteriorly onto the chest wall and some prostheses had internal echoes. To evaluate these findings, in vitro B-scanning was performed on three different commonly used mammary prostheses: the silicone gel, the saline inflatable, and the double-membrane gel-inflatable type. Ultrasound study of the augmented breast allowed evaluation of breast abnormalities in the parenchyma overlying the prostheses and also permitted evaluation of the complications unique to the implantation procedure: abscess formation, displacement of the implants, fibrous capsule formation, and wrinkles or cracks within the implant.

Ultrasound mammography for the augmented breast.

Fourteen men referred for ultrasound evaluation of breast enlargement had ultrasound mammography using water path techniques. Gynecomastia, both the localized type and the diffuse type, could be differentiated from the normal soft tissues of the chest wall on the B-scans. Among nine cases of men who underwent excision, there were six cases of gynecomastia, two lipomas, and one biopsy revealed normal subcutaneous tissue. The ultrasound B-scan images are correlated with the histologic findings in these nine cases. Ultrasound mammography using water path techniques is a useful imaging examination for male breast enlargement.

A S Patchefsky

Papers

Ultrasound mammography: a comparison with radiographic mammography.

Clinical experience with a prototype real-time dedicated breast scanner.

Ultrasound mammography for the augmented breast.

Ultrasound mammography for male breast enlargement