Efficacy of ultrasonography and mammography in detecting features of breast cancer

Abstract

Introduction: Breast cancer (BC) is considered one of the most commonly diagnosed cancers. Early detection is critical for effective management. This study aims to assess the utility of ultrasonography (US) and mammography (MG) in detecting BC features.

Methods: This retrospective cross-sectional study involved the electronic records of 263 female patients diagnosed with BC. The mean age was 45.71 ± 12.25 years (17-90 years). A cross-tabulation test was performed to correlate the presence of each malignant feature (Yes/No) on both US and MG and the final ultrasonography diagnosis (benign/malignant). The compatibility between the presence of each feature on both imaging techniques was measured by the percentage of agreement in reporting the feature that was reported as Kappa. The sensitivity and specificity for each feature were calculated, and the receiver operating characteristic curve was used to measure the area under the curve for each feature on both modalities.

Results: The strong compatibility between the two techniques was 87.1%, 94.29%, 66.92%, 79.85%, 77.56%, 77.18, and 79.84% for irregular shape, uncircumscribed, spiculated margins, tissue distortion, nipple retraction, skin thickening, and the presence of lymphadenopathy, respectively (P < 0.001). Boxplots show that the sensitivity of the US ranged from 37% to 95%, and the specificity ranged from 27% to 91%. However, MG's sensitivity ranged from 44% to 93%, and the specificity ranged from 36% to 73%.

Conclusion: US and MG images show similar morphological changes, enhancing diagnostic accuracy in breast lesions. US characterizes echogenicity, provides real-time imaging, and uses color and pulsed Doppler techniques for vascularity and lymphadenopathy detection, while MG is better for identifying different calcification types.

Keywords: Breast cancer; irregular shape of breast lesion; mammography; spiculated margins of breast lesion; ultrasonography.

Figure 1

Selected US images of two different patients, shows (a) an irregular shape, spiculated margin, longer than wider, hypoechoic mass perpendicular to the skin line. (b) An irregular shape, circumscribed margin, lobulated, hypoechoic mass, and histologically proven intraductal carcinoma

Figure 2

Selected MG images of the right breast of the same patient: (a) craniocaudal (CC) and (b) mediolateral oblique (MLO) shows irregular spiculated dense mass in the upper outer quadrant associated with architecture distortion (star), clustered microcalcification (short arrows), and rounded dense axillary lymph nodes (long arrows)

Figure 3

Poxplot shows that US’s highest sensitivity and specificity are 95% and 91%. However, MG’s highest sensitivity and specificity are 93% and 82%

Figure 4

ROC curve shows the AUC of each feature of BC on US and revealed that AUC of irregular shape = 0.595, AUC of uncircumscribed = 0.611, AUC of speculated margins = 0.637, AUC of tissue distortion = 0.707, AUC of nipple retraction = 0.611, AUC of skin thickening = 0.647, AUC of lymphadenopathy = 0.575

Figure 5

ROC curve shows the AUC of each feature of BC on MG and revealed that AUC of irregular shape = 0.602, AUC of uncircumscribed = 0.510, AUC of spiculated margins = 0.576, AUC of tissue distortion = 0.701, AUC of nipple retraction = 0.582, AUC of skin thickening = 0.643, AUC of lymphadenopathy = 0.640