The whole is greater than the sum of its parts - Evaluation of breast lesions by digital mammography and ultrasound along with fine needle aspiration cytology correlation

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BACKGROUND: This prospective observational study was done to assess the role of digital mammography (MG) with high-resolution ultrasonography (USG) in the evaluation of breast lesions and to compare the sensitivity and specificity of digital MG and USG with fine needle aspiration cytology for diagnosis of breast lesions. MATERIALS AND METHODS: This study was conducted for a period of 22 months, from August 2022 to May 2024. The study was performed in an unscreened population and comprised of all the patients referred to the Department of Radiodiagnosis and Imaging, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, with breast complaints. USG was performed on all participants using a high-frequency (7.5–13 MHz) transducer. MG was done for participants above 35 years or those with significant history or USG findings. RESULTS: A significant correlation was observed between the BIRADS classifications of MG and USG ( P < 0.001), with higher BIRADS scores on both modalities correlating with a higher likelihood of malignancy. This correlation underscores the value of a combined imaging approach in the accurate diagnosis and classification of breast lesions. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MG in diagnosing malignancy were 87.23%, 71.7%, 73.21%, and 86.36%, respectively. The Cohen’s κ value was 0.583, indicating a moderate strength of agreement between the two modalities. The sensitivity, specificity, PPV, and NPV of USG in diagnosing malignancy were 89.4%, 69.8%, 72.4%, and 88.1%, respectively. The Cohen’s κ value was 0.584, indicating a moderate strength of agreement between the two modalities. The sensitivity, specificity, PPV, and NPV of USG in diagnosing malignancy as compared to MG were 82.1%, 72.6%, 78%, and 76.2%, respectively. The Cohen’s κ value was 0.551, indicating a moderate strength of agreement between the two modalities. CONCLUSION: The study concluded that integrating digital MG and high-resolution USG significantly enhances the diagnostic accuracy in evaluating breast lesions.

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