The use of ultrasound by breast surgeons in outpatients: an accurate extension of clinical diagnosis

Aims: To assess the accuracy of breast ultrasound scan (USS) performed by a surgeon in outpatients and to evaluate the additional contribution of USS to clinical diagnosis. Methods: A prospective study of 302 patients with symptomatic breast diseas e (322 lumps) was performed. Group I consisted of 213 clinic USS of lumps s urgically removed for appropriate clinical indications. In Group 2, a USS w as performed on 231 lumps by both the surgeon and radiologists as part of t riple assessment. Each clinic USS was compared to the surgical pathology (G roup 1) or USS performed by the radiologist (Group 2). Results: In Group I (n=213), 89 lumps were proven benign and 124 malignant on histology. Ultrasound scans performed by the surgeon compared to histolo gy had a sensitivity of 98.3% and specificity of 91.7%. An abnormal clinic USS heightened the index of suspicion in 22/213 (10.3%) of cases felt clini cally to be benign but subsequently confirmed malignant on histology. Fifty -seven lumps felt to be indeterminate clinically were correctly identified on USS by surgeon as benign (n=56) or malignant (n=1). In Group 2 (n=231), there was complete concordance of USS scans by surgeon and radiologists in 197 (96%) and complete discordance in eight (3.9%) patients. Of the discord ant scans, the surgeon correctly identified 7/8 diagnoses on histology. A U SS examination by the radiologists provided a correct diagnosis of 6/14 sca ns scored by the clinician as indeterminate. Conclusion: USS performed in outpatients by a breast surgeon is accurate an d a useful adjunct to clinical assessment. This enables rapid diagnosis in one-stop breast clinics, selecting difficult diagnostic procedures for USS by radiologists at the same visit. (C) 2001 Harcourt Publishers Ltd.