title: How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population?
abstract: OBJECTIVE
  To assess the ability of mammography and ultrasound individually and in combination to predict whether a breast abnormality is benign or malignant in patients with symptomatic breast disease.
  
  
  METHODS
  Patients included were those in whom histological confirmation of the abnormality following surgical excision was available. Mammographic and ultrasound appearances were prospectively classified using a four-point scale (1 = no significant lesion, 2 = benign lesion, 3 = possibly malignant, 4 = probably malignant).
  
  
  RESULTS
  Histological confirmation following surgical excision was available in 559 patients, of which 303 were benign and 256 were malignant. The imaging classification was correlated with histology in these 559 lesions. In predicting final histology, the sensitivity and specificity of mammography alone were 78.9 and 82.7%, respectively, of ultrasound alone were 88.9 and 77.9%, respectively, and of mammography and ultrasound in combination were 94.2 and 67.9%, respectively. Only one patient had both a mammogram and ultrasound reported as normal (category 1 for both tests) in whom subsequent histology revealed a carcinoma (0.4% of all carcinomas).
  
  
  CONCLUSIONS
  We found that the extensive use of ultrasound increases the cancer detection rate in this selected population by 14%.
authors.affiliation: Department of Radiology, Addenbrooke's Hospital Cambridge and University of Cambridge, UK.
authors.forename: H A
authors.initials: HA
authors.lastname: Moss
authors.forename: P D
authors.initials: PD
authors.lastname: Britton
authors.forename: C D
authors.initials: CD
authors.lastname: Flower
authors.forename: A H
authors.initials: AH
authors.lastname: Freeman
authors.forename: D J
authors.initials: DJ
authors.lastname: Lomas
authors.forename: R M
authors.initials: RM
authors.lastname: Warren
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary