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Breast Imaging |
1 From the Iris Cantor Center for Breast Imaging, Department of Radiological Sciences, UCLA School of Medicine, 200 UCLA Medical Plaza, Rm 165-49, Los Angeles, CA 90095-6952 (G.R., A.C.S., J.S.P., J.W.S., L.W.B.); the Department of Radiology, Olive View-UCLA Medical Center, Sylmar, Calif (G.C.H.); the West Los Angeles Veterans Administration Medical Center, Calif (M.L.M.); and the Department of Radiology, Indiana University School of Medicine, Indianapolis (H.E.R., V.P.J.). From the 1996 RSNA scientific assembly. Received August 4, 1998; revision requested September 4; final revision received March 16, 1999; accepted July 1. Address reprint requests to L.W.B.
PURPOSE: To investigate the general applicability and interobserver variability of ultrasonographic (US) features in differentiating benign from malignant solid breast masses.
MATERIALS AND METHODS: One hundred sixty-two consecutive solid masses with a tissue diagnosis were reviewed. Three radiologists reviewed the masses without knowledge of clinical history or histologic examination results.
RESULTS: US features that most reliably characterize masses as benign were a round or oval shape (67 of 71 [94%] were benign), circumscribed margins (95 of 104 [91%] were benign), and a width-to–anteroposterior (AP) dimension ratio greater than 1.4 (82 of 92 [89%] were benign). Features that characterize masses as malignant included irregular shape (19 of 31 [61%] were malignant), microlobulated (four of six [67%] were malignant) or spiculated (two of three [67%] were malignant) margins, and width-to–AP dimension ratio of 1.4 or less (28 of 70 [40%] were malignant). If the three most reliable criteria had been strictly applied by each radiologist, the overall cancer biopsy yield would have increased (from 23% to 39%) by 16%. When US images and mammograms were available, the increase in biopsy yield contributed by US was not statistically significant (2%, P = .73). However, in independent reviews, one to three reviewers interpreted four carcinomas as benign at US.
CONCLUSION: The data confirm that certain US features can help differentiate benign from malignant masses. However, practice and interpreter variability should be further explored before these criteria are generally applied to defer biopsy of solid masses.
Index terms: Breast, US, 00.12981, 00.12985 • Breast neoplasms, diagnosis, 00.12981, 00.12985, 00.30 • Breast neoplasms, radiography, 00.11, 00.30 • Breast neoplasms, US, 00.12981, 00.12985, 00.30 • Breast radiography, comparative studies, 00.11
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