COMPARISON OF GRAY SCALE IMAGING AND DOPPLER ULTRASOUND WITH MAMMOGRAPHY FOR DIFFERENTIAL DIAGNOSIS OF BENING AND MALIGNANT SOLID BREAST LESION TAKING BIOPSY AS A GOLD STANDARD

Abstract

Background: Breast cancer is complicated and very heterogenous malignancy and the major cause of mortality in women associated with cancer in the rest of the world and in Pakistan. The situation with delayed clinical manifestation is a critical crisis in the population health. Although the conventional digital mammography is a universal baseline screening modality, its diagnostic sensitivity is much lower in younger women and dense-fibroglandular tissue since the radiological masking effect is induced. High-resolution gray-scale ultrasound and color Doppler imaging integration is shown to be an important add-on technique that addresses these limits of anatomy to enhance early detection.

Objective: To assess and compare the diagnostic accuracy, sensitivity and specificity of high-resolution gray-scale ultrasound combined with color Doppler versus standard digital mammography in accurately differentiating between benign and malignant histological lesions of the solid breast tissue using a definitive gold standard of histopathological biopsy.

Methodology: The current study used the cross-sectional analysis design, which was carried out in Jinnah Hospital Lahore. Eighty female patients who presented with solid breast mass were randomly sampled and a total of 80 individuals were used. All the participants were subjected to routine mammography, high-frequency gray-scale ultrasound, and color Doppler imaging after which a definite core needle or surgical biopsy had to be done in order to verify the histopathological diagnosis.

Results: Eighty female participants were involved in the study and the highest rate of breast lesions (43.8) was recorded in the 40-55 years age group. Histopathological biopsy proved that 68 lesions (85.0%) were benign and 12 lesions (15.0) invasive malignant carcinomas. Heterogeneously or extremely dense breast tissue appeared in almost half of the population (47.5) presented. Standard mammography showed a sensitivity of 75.0% as well as specificity of 95.6 with a significant omission of 3 malignant cases (false negatives) all together because of the dense tissue masking effect. On the other hand, gray-scale morphology and color Doppler hemodynamics (for central vascularity) used synergistically was successful in penetrating dense tissue to produce a perfect sensitivity of 100.0% as well as a specificity of 94.1 having correctly identified all malignant cases.

Conclusion : The present study establishes with no doubt that, a combination of gray-scale and colour Doppler ultrasound gives the best diagnostic accuracy compared to the traditional digital mammography in the assessment of solid breast lesion. Mammography is crippled by false-negative results especially in dense fibroglandular tissue, but adjunctive ultrasound effectively alleviates masking effect. The findings point to the absolute clinical imperative of focused ultrasound as an imperative diagnostic complement to avoid the occurrence of late oncological diagnosis, less surgical biopsy of benign masses and increased patient survival rates.