Sonographic findings in women with mammographically dense breast tissue at Mulago Hospital.

Abstract

Back ground The incidence rate of breast cancer in sub-Saharan nations is increasing. In Uganda, the incidence of breast cancer has tripled in the past three decades. Mammography, the gold standard for breast cancer screening misses many cancers, especially in women with dense breasts. In Uganda, breast cancer peaks in younger women who are more likely to have dense breasts. Ultrasound is a proven cost effective diagnostic tool in dense breasts. Objective: To describe sonographic features of breast lesions using BI-RADS lexicon in women with mammographically dense breasts. Methodology: A cross sectional descriptive study was done on women referred for mammography at Mulago hospital radiology department. A total of 148 women with mammographically dense breasts tissue were recruited during a study period of six months. All underwent bilateral breast ultrasound, lesions seen were described using sonographic BI-RADS lexicon and a final assessment categorization was made. Subsequently US guided biopsies were performed on 43 women. Results: Sonographic features which significantly suggests malignancy includes; irregular shape, non-parallel orientation, non circumscribed margin, echogenic halo, and increased vascularity of the lesion (P<0.005). Typical sonofeatures of benign mass lesions includes an oval shape, parallel orientation and circumscribed margin. Prevalence of breast cancer in symptomatic women with mammographically dense breasts was 15% (22/148). Mammography detected 16/22(73%) and missed 6/22(27%). Ultrasound diagnosed six mammographically occult cancer cases in dense breasts. Conclusion: Prevalence of breast cancer was three folds high among these symptomatic women with dense breasts. BI-RADS sonographic lexicon is helpful in distinguishing malignant from benign mass lesions. Ultrasound is recommended in routine evaluation of dense breasts.