Objective: To determine the change over mammographic diagnosis, BI-RADS category and management following targeted ultrasound of an indeterminate lesion seen on mammography and associated factors, if any.
Study design: Descriptive, analytical study.
Place and duration of study: Radiology Department, The Aga Khan University Hospital and Clifton Medical Services, Karachi, from April 2010 to May 2011.
Methodology: Patients referred for targeted breast ultrasound following X-ray mammography were selected regardless of age. Targeted Ultrasound (TUS) was defined as a limited ultrasound of a specific lesion or breast part as indicated by the referring source. Comparison was made between the post mammography and post TUS lesion characterization, diagnosis and BI-RADS category (0-5) which was taken as a measure of management change. Those were evaluated to determine significance of age, marital status, parity, breast parenchymal pattern ( dense, fatty, heterogeneous), referring source for the TUS (radiology resident, radiologist or surgeon), lesion characteristics (density, echogenecity, shape, location, margins, size, depth-to-width ratio, enhancement or shadowing), presenting symptoms or signs and reason for TUS. Ap-value of 0.05 or less was taken as significant.
Results: There were a total of 342 patients with mean age of 49.7 ±13.5 years. It assigned a definite category in 232 patients with an indefinite category (0) on mammography requiring further investigation. It decreased the suspicion for malignancy in 180 (77.58%) by assigning a low BI-RADS category and increased the suspicion in 52 (22.41%). The factors significantly associated with this changes included clinical indication being diagnostic (p < 0.001), lesion characteristics on imaging (p < 0.001), heterogenous breast parenchymal pattern (p < 0.001) and presence of known risk factors (p=0.049).
Conclusion: TUS served as a problem solving tool in the evaluation and management of an indeterminate breast lesion in a high number of patients, particularly when there was a lump as indication for imaging in the presence of risk factors in a patient with otherwise heterogeneously dense breast parenchyma.
Publication ( Name of Journal)
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP
(2015). Targeted ultrasound of an indeterminate breast lesion on mammography: When does it influence management?. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 25(8), 564-567.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/412