SOLID BREAST NODULES - USE OF SONOGRAPHY TO DISTINGUISH BENIGN AND MALIGNANT LESIONS

PURPOSE: To determine whether sonography could help accurately disting uish benign solid breast nodules from indeterminate or malignant nodul es and whether this distinction could be definite enough to obviate bi opsy. MATERIALS AND METHODS: Seven hundred fifty sonographically solid breast nodules were prospectively classified as benign, indeterminate , or malignant. Benign nodules had no malignant characteristics and ha d either intense homogeneous hyperechogenicity or a thin echogenic pse udocapsule with an ellipsoid shape or fewer than four gentle lobulatio ns. Sonographic classifications were compared with biopsy results. The sensitivity, specificity, and negative and positive predictive values of the classifications were calculated. RESULTS: Benign histologic fe atures were found in 625 (83%) lesions; malignant histologic features, in 125 (17%). Of benign lesions, 424 had been prospectively classifie d as benign. Two lesions classified as benign were found to be maligna nt at biopsy. Thus, the classification scheme had a negative predictiv e value of 99.5%. Of 125 malignant lesions, 123 were correctly classif ied as indeterminate or malignant (98.4% sensitivity). CONCLUSION Sono graphy can be used to accurately classify some solid lesions as benign , allowing imaging follow-up rather than biopsy.