To evaluate the role of sonography as an adjunct to mammography in women with dense breasts.

OBJECTIVE To assess the role of sonography as an adjunct to mammography in women with dense breast tissue by determining yield and validity of sonography using histopathology/follow-up mammography as gold standard. METHODS It was a descriptive analytical study conducted at the Radiology Department of Aga Khan University Hospital, from September 2005 to April 2007. A total of 76, mammographically dense breasts were evaluated with ultrasound. Of these 32 had palpable lumps on mammography, and were excluded from the study. A total of 44 patients had either symptoms of vague nodularity, nipple discharge, mastalgia or had no symptoms and the mammograms showed dense breast parenchyma without any focal abnormality. All these patients underwent whole breast ultrasound. The findings on ultrasound and subsequent histopathology and follow-up mammography were used to calculate the sensitivity, specificity, positive and negative predictive value of whole breast ultrasound as an adjunct to mammography. RESULTS The age range of patients was 35 to 56 years, mean age was 42 +/- 7.33 years. Of the 44 patients included, 37 had normal ultrasound examinations and had the same findings on one year follow-up mammograms and ultrasound examinations. The remaining, seven patients were categorized as BI RADS category 4 due to presence of suspicious findings on ultrasound examination. They underwent ultrasound guided biopsy of the detected lesions. Out of seven solid lesions biopsied six were benign and one was reported malignant on histopathological examination. The sensitivity, specificity, positive and negative predictive values were 100%, 85%, 14% and 86% respectively. CONCLUSION Breast ultrasound can be a useful adjunct to mammography in women with dense breast by detecting small cancers not identified on mammography or clinical breast examination. Larger studies will be required to suggest that ultrasound could be used as an adjunct.