A PROSPECTIVE ANALYSIS OF OFFICE-BASED BREAST ULTRASOUND

Objective: To determine the usefulness of office-based breast ultrasou nd. Design: Prospective, nonrandomized study. Setting: Academic-affili ated community teaching hospital. Patients: Among 653 consecutive pati ents seen in our office during a 30-month period, we performed 660 ult rasound examinations. The presenting complaint included a palpable mas s in 53%, abnormal mammogram in 39%, and nipple discharge or retractio n in 3%. Intervention: Ultrasound examination was performed using a ha ndheld 7.5-MHz linear array transducer. Findings and pertinent clinico pathologic data were recorded prospectively in our Breast Ultrasound R egistry. Main Outcome Measure: Contribution of breast ultrasound to di agnosis and treatment. Results: The sonogram was normal in 201 cases ( 30%), showed duct ectasia in 20 cases (3%), a simple cyst or seroma in 101 cases (15%), and a focal complex or solid abnormality in 338 case s (51%). Among the last group, 114 (97%) of 118 lesions thought to be benign on ultrasonography proved to be benign, whereas 13 (12%) of 111 indeterminate and 72 (75%) of 96 sonographically suspicious lesions p roved to be cancer (including 13 cases with normal mammograms). Ultras onographic features of malignancy included an anteroposterior-to-later al dimension ratio of 1 or greater, heterogeneous hypoechoicity, irreg ular shadowing, and fuzzy and/or jagged margins. Ultrasound-guided nee dle biopsy accurately diagnosed 46 benign nonpalpable lesions and 20 m alignant nonpalpable lesions. Conclusions: These data suggest that ult rasonography is a useful adjunct to clinical and mammographic evaluati on of breast disease. Breast ultrasound identifies cysts, aids in diff erentiating benign from malignant lesions, and facilitates office need le biopsy of nonpalpable abnormalities, permitting timely and cost-eff ective patient care.