Multicentric and multifocal cancer: Whole-breast US in preoperative evaluation

PURPOSE: To evaluate preoperative whole-breast ultrasonography (US) in the management of breast cancer. MATERIALS AND METHODS: The ipsilateral breast in 40 patients with known bre ast cancer or in whom there was high suspicion of breast cancer was evaluat ed with whole-breast US. Biopsy was performed on all discrete solid lesions . RESULTS: US depicted 45 (94%) of 48 invasive tumor foci and seven (44%) of 16 foci of ductal carcinoma in situ (DCIS). Mammography depicted 39 (81%) o f 48 invasive tumor foci and 14 (88%) of 16 foci of DCIS. The nine (14%) of 64 malignant foci seen only at US included three infiltrating ductal carci nomas, two mixed infiltrating and intraductal carcinomas, two infiltrating lobular carcinomas, and two foci of DCIS. Two (18%) of 11 foci of infiltrat ing lobular carcinoma were missed at both US and mammography. Of 20 patient s mammographically suspected of having unifocal disease three (15%) require d wider excision on the basis of US findings. Two additional foci were depi cted only at US in one of 16 patients mammographically suspected of having multicentric or multifocal disease. Of four patients with mammographically occult disease, US correctly depicted the diffuse (n = 2) or unifocal (n = 2) extent of the cancer. CONCLUSION: Whole-breast US complements mammography in the preoperative eva luation of patients with breast cancer, particularly when breast conservati on is contemplated.