Journal of Korean Society of Medical Ultrasound 2003;22(2): 59-65.
Effectiveness of Ultrasonography in Differential Diagnosis of Nonpalpable Breast Nodules.
Young Kyung Lee, Sun Mi Kim, Jeong Mi Park
Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Korea.
  Published online: June 1, 2003.
PURPOSE: We evaluated the effectiveness of ultrasonography (US) in differential diagnosis of nonpalpable breast nodules. MATERIALS AND METHODS: From January 2000 to June 2001, US-guided fine needle aspiration biopsy (FNAB) was performed in 610 nonpalpable breast nodules from 511 patients. Pre-biopsy US diagnosis was divided into 311 benign and 299 non-benign (malignant and indeterminate) categories. Diagnostic accuracy of Pre-biopsy US was calculated according to the size of lesion. All lesions were pathologically diagnosed by US-guided FNAB while excisional biopsy was performed in 12 cases. RESULTS: Overall, 136/143 FNAB-proven malignant nodules (95.1%) and 304/467 FNAB-proven benign nodules (65.1%) were correctly predicted by US. The overall diagnostic accuracy was 72.1% while the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were highest for the nodules sized between 1-2cm in the longest diameter (98.1%, 70.1%, 47.7%, 99.2% and 76.2%, respectively). The number of false negative malignancies were seven (4.9%); four of them, smaller than 1cm. False negative malignancies showed ovoid or round in shape, well defined margin and homogeneous echogenecity. Meanwhile, frequent US findings of indeterminate nodules included ill-defined margin, microlobulated border, angular margin and marked hypoechogenecity; however, 86% of them were proved to be benign. CONCLUSION: Ultrasonography is an effective diagnostic method in differential diagnosis of nonpalpable breast nodules, especially for 1-2 cm sized nodules. However, US characteristics suggestive of malignacy were also frequently seen in benign lesions.
Keywords: Breast; Breast neoplasms, diagnosis; Breast neoplasms, US
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