Abstract
Purpose
This study evaluated the role of the correct diagnostic pathway through conventional imaging in evaluating breast disease.
Materials and methods
Six hundred patients aged between 35 and 75 years were enrolled in the study. All patients underwent detailed history and clinical examination, ultrasound (US) and mammography. US scans were repeated after mammography. All suspicious lesions were studied by cytological and histological characterisation and magnetic resonance (MR) imaging.
Results
The first US scan showed 147 solid lesions, 67 lesions characterised by posterior acoustic shadowing and 193 areas of heterogeneous echostructure. The second US scan, performed after mammography, confirmed 123/147 solid nodular lesions, 53/67 lesions characterised by posterior acoustic shadowing and 183/193 areas of heterogeneous echostructure; it also showed 13 nodular lesions not seen on the first scan and two cases of nodular lesions with irregular calcifications.
Conclusions
Our experience suggests that US not performed in conjunction with mammography gives rise to incorrect diagnostic interpretations (either false positive or false negative results). The detection rate of the US scan performed after mammography increases from 4.16% to5.5%.
Riassunto
Obiettivo
Scopo del nostro lavoro è stato valutare il ruolo del corretto iter diagnostico nell’imaging convenzionale nello studio della patologia mammaria.
Materiali e metodi
Sono state esaminate 600 pazienti (35–75 anni) sottoposte ad anamnesi, esame clinico, ecografia e mammografia. È stata effettuata successivamente una rivalutazione ecografica, alla luce della mammografia. Tutte le pazienti con lesioni sospette hanno proseguito il loro iter diagnostico mediante esame cito-istologico e/o risonanza magnetica.
Risultati
La prima ecografia ha documentato 147 lesioni nodulari solide, 67 casi di sbarramento del fascio ultrasonoro e 193 aree di disomogeneità ecostrutturale. Il secondo esame ecografico, eseguito successivamente alla mammografia, ha confermato 123/147 lesioni nodulari solide, 53/67 casi di sbarramento del fascio ultrasonoro e 183/193 aree di disomogeneità ecostrutturale. Sono state inoltre individuate 13 ulteriori lesioni nodulari non evidenziate alla preliminare ecografia ed in due casi abbiamo riscontrato la presenza di substrato nella sede del reperto mammografico di microcalcificazioni.
Conclusioni
Dal nostro studio è emerso che l’ecografia effettuata senza la possibilità di riscontro mammografico, ha dato luogo ad erronee interpretazioni diagnostiche intese sia come falsi positivi che come falsi negativi e secondo i nostri dati, qualora eseguita successivamente alla mammografia, ha consentito di incrementare il valore della detection rate dell’indagine ecografica da 4,16% a 5,5%.
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Pistolese, C.A., Perretta, T., Cossu, E. et al. Value of the correct diagnostic pathway through conventional imaging (mammography and ultrasound) in evaluating breast disease. Radiol med 116, 584–594 (2011). https://doi.org/10.1007/s11547-011-0657-x
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DOI: https://doi.org/10.1007/s11547-011-0657-x