Evaluation of Breast Cancer Risk With Supplementary Ultrasonography to Characterize Palpable Lumps in Mammographically Dense Breasts

Abstract

Background: Breast lumps are one of the common problems encountered in women. These lumps are frequently seen in younger to middle aged women and often they go undetected for various reasons. These lumps have different etiologic causes and can be either benign or malignant.Objective: To evaluate prediction of pathological type of different breast lesions, and the sensitivity and specificity of BI-RADS Scoring system using a modified triple test. Patients and methods:This prospective observational study included fifty patients complaining of palpable breast masses came to Department of Surgery Al-Azhar University Hospitals (Al-Hussein and Bab Al-Sha'reia University Hospitals), Each patient underwent a modified triple test which included a complete clinical examination, next was the mammography and ultrasound examination of the breast mass, and finally fine needle aspiration of the breast lump was made. Based on each test, the palpable breast lumps were classified as benign, malignant or inconclusive. Then investigate, how accurately using the BI-RADS assessment categories for diagnosing breast cancer, Data of the study were collected during the period from July 2018 to June 2019 for analysis by statistical program SPSS, then Microsoft Excel sheets were used to graph the results and integrated into Microsoft Word.Results: Clinical examination had sensitivity of 86.34 % and specificity of 91% for the detection of malignancy. Positive predictive value of clinical examination was 85%, and negative predictive value was 84.42%. Ultrasound findings suggestive of malignancy had biopsy proven malignancy. Ultrasound had a sensitivity of 86.84% and specificity of 100% for the detection of malignancy, Positive predictive value for detection of malignancy was 100%, Negative predictive value to rule out malignancy was 92.86%.By Using modified triple test, 18 patients (36%) had features suggestive of malignant disease, and 32 patients (64%) were suspected to have benign breast disease. All of the 18 patients suspected to have malignancy on Modified Triple Test were biopsy proven to have malignant breast disease. Conclusion:Modified Triple Test had a sensitivity, specificity, positive predictive value and negative predictive value of 97.36%, 100%, 100% and 98.48% .respectively. Benign cases can be safely followed up without furtherprocedure (open biopsy) that avoiding the surgical morbidity and scar, and also those found to be malignant on Modified Triple Test can directly proceed to definitive surgical management.