ROLE OF HIGH-FREQUENCY ULTRASONOGRAPHY IN THE EVALUATION OF PALPABLE BREAST MASSES IN CHINESE WOMEN - ALTERNATIVE TO MAMMOGRAPHY

We prospectively assessed the accuracy of high resolution breast ultra sonography in the diagnosis of palpable breast masses in comparison to clinical palpation and x-ray mammography. Four hundred and eight Chin ese women with palpable breast lumps had clinical assessment followed by ultrasonography of the breast, mammography (for women over 35 years ), and fine needle aspiration cytology. Excisional biopsy or surgery w as performed for suggestive lesions. The clinical, mammographic and ul trasound diagnoses were compared with the final pathologic diagnosis. In the determination of whether a lesion was malignant, the sensitivit y, specificity, and positive predictive values were 97%, 97%, and 85%, respectively, for ultrasonography; 92%, 94%, and 84%, respectively, f or mammography; and 88%, 92%, and 67%, respectively, for clinical eval uation. The specificity for combined clinical palpation and ultrasonog raphy was higher (99%) than that for combined clinical palpation and m ammography (96%). Addition of ultrasonography to combined clinical pal pation and mammography increased specificity. Mammography in addition to combined clinical palpation and ultrasonography did not significant ly improve the sensitivity, specificity, or positive predictive value. This limited usefulness raises the question as to whether it should b e eliminated in the workup of a palpable mass in the average Chinese p atient. Its main advantage is the detection of extended foci of carcin oma in situ related to a palpable mass, which often is undetected by u ltrasonography.