Diagnostic Validity of Ultrasound Elastography and B Mode Ultrasound with Mammography in Solid Breast Masses in Correlation with Histopathological Examination

Background: Global breast cancer incidence increases at an annual rate of 3·1%. Over 100,000 new breast cancer patients are estimated to be diagnosed annually in India. Early, sensitive and accurate diagnosis lead to better prognosis and reduce the risk of death caused by breast cancer by 40% or more. Objective: To compare the diagnostic validity of mammography combined with B mode ultrasound and ultrasound elastography in detection of the nature of breast lesions (benign or malignant) separately and in combination with histopathology (HPE) as the gold standard. Methods: This prospective study conducted in a tertiary care teaching hospital included 100 female patients who came for screening or diagnostic mammography and had solid breast lesions of BIRADS category 3 and above. Patients with simple and complicated cystic lesions were excluded from the study. Socio demographic details and family history details were collected from the study participants and then subjected to mammography and B mode ultrasonography and further analysed with Ultrasound Elastography. Patients who have all the above examination findings were subjected to fine needle aspiration cytology (FNAC) / Biopsy / surgery to obtain the histopathology examination findings. The data collected were entered in MS Excel and analysed using SPSS software version 21. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the investigations were determined. Results: Among the 100 cases, 75 cases were diagnosed as malignant and 25 cases as benign by histopathological diagnosis. Of the 75 malignant cases, 73 were found to be infiltrating ductal carcinoma and one case of malignant phylloides tumour and papillary carcinoma each. The Ultrasound along with mammography had a sensitivity of 98.6% and specificity of 68% in diagnosing malignant breast carcinomas with accuracy of 91% (83.7% - 95.2%). The Elastography had a sensitivity of 97.3% and specificity of 64% with accuracy of 89% (81.3% - 93.7%). The Elastography combined with Ultrasound and mammography findings, had a sensitivity of 97.3% and specificity of 84% with accuracy of 94% (87.5% - 97.2%). Conclusions: Ultrasound Elastography and mammography combined with B mode ultrasound in evaluation of solid breast lesions for predicting malignancy had a good sensitivity and predictive values of which USG with mammography had a slightly higher validity than USG Elastography. When combined USG with mammography and Elastography, the specificity is very much increased and the accuracy of prediction is higher than compared to the investigations conducted individuall