From the Guidelines
Ultrasound is highly accurate for diagnosing breast masses, with a sensitivity of 95-97% and specificity of 80-94% for distinguishing between benign and malignant lesions, as reported in the most recent guidelines 1. For optimal results:
- Use high-frequency (7-12 MHz) linear transducers
- Perform both grayscale and color Doppler imaging
- Assess multiple characteristics: shape, margins, echogenicity, posterior features, and vascularity Ultrasound is particularly useful for:
- Evaluating palpable masses, especially in dense breasts
- Characterizing lesions found on mammography
- Guiding biopsies of suspicious lesions Limitations to consider:
- Less effective for detecting microcalcifications compared to mammography
- Operator-dependent, requiring experienced sonographers
- May miss some small or deep lesions The diagnostic accuracy of ultrasound for breast masses is supported by the National Comprehensive Cancer Network (NCCN) guidelines, which recommend ultrasound as a primary imaging modality for evaluating palpable masses in women aged 30 years or older 1. The guidelines also emphasize the importance of geographic correlation between clinical and imaging findings, as well as the use of ultrasound to guide tissue biopsy 1. Additionally, the American College of Radiology (ACR) Appropriateness Criteria for palpable breast masses highlight the importance of imaging evaluation, including ultrasound, in the diagnosis of breast masses 1.
Key points to consider when using ultrasound for breast mass diagnosis include:
- The negative predictive value of mammography with ultrasound in the context of a palpable mass ranges from 97.4% to 100% 1
- Ultrasound is particularly useful for evaluating palpable masses in dense breasts, where mammography may be less effective
- The use of high-frequency linear transducers and assessment of multiple characteristics, such as shape and margins, can improve the accuracy of ultrasound diagnosis
- Ultrasound-guided biopsy is a valuable tool for obtaining tissue samples from suspicious lesions, and concordance between pathology, imaging, and clinical findings must be obtained 1.
From the Research
Diagnostic Accuracy of Ultrasonography for Breast Masses
The diagnostic accuracy of ultrasonography for breast masses is a topic of interest in the medical field. Studies have shown that ultrasound can be a useful tool in evaluating breast masses, particularly in differentiating cystic from solid masses.
- The sensitivity of ultrasound in detecting breast lumps was found to be 92.5% 2.
- The sensitivity and specificity of ultrasound for detecting breast carcinoma were found to be 57.1% and 62.8%, respectively, with a positive predictive value of 68.1% and a negative predictive value of 99.5% 2.
- Ultrasound can reliably differentiate cystic from solid breast masses, and is significant in detecting suspicious breast masses 2, 3, 4.
- Breast ultrasound can also guide needle biopsy of suspicious breast lesions and lymph nodes, and can be valuable in staging breast cancer 3.
- The use of advanced ultrasound techniques, such as harmonic imaging, Doppler imaging, and elasticity imaging, can improve the diagnostic accuracy of breast ultrasound 3, 5.
Limitations and Challenges
Despite the potential benefits of ultrasound in evaluating breast masses, there are limitations and challenges to its use.
- Observer variability remains an important obstacle in the interpretation of ultrasound images 6.
- The sensitivity of ultrasound for detecting breast carcinoma can be lower than other imaging modalities, such as mammography 2.
- The use of ultrasound as a screening tool for breast cancer is not widely recommended, due to its limited sensitivity and specificity 4, 5.
Clinical Applications
Ultrasonography can be a useful adjunct to mammography in the evaluation of breast masses, particularly in cases where mammography is limited, such as in dense breast parenchyma.