Positive predictive value for additional synchronous breast lesions in whole-breast sonography at the diagnosis of breast cancer: Clinical and imaging factors

Abstract

Purpose: To evaluate the positive predictive value (PPV) of bilateral whole-breast ultrasonography (BWBS) on detection of synchronous breast lesions on initial diagnosis of breast cancer and evaluate factors affecting PPV of BWBS according to variable clinical and imaging factors.Methods: Total 75 patients who had synchronous lesions with pathologic confirmation at the initial diagnosis of breast cancer during Jan 2007 and Dec 2007 were included. Clinical factors of the patient such as age, history of breast cancer and menopause status was evaluated. One observer retrospectively reviewed mammography and BWBS images of the index breast cancer lesion and the synchronous lesion. The PPV for additional biopsy was calculated for BWBS and variable clinical and imaging factors affecting the PPV for BWBS was evaluated.Results 97 synchronous breast lesions were included. Overall PPV for additional biopsy was 21.6%. The PPV for synchronous lesions detected only on mammography, detected both on mammography and BWBS, detected only on BWBS was 11.1%, 76.9% and 14.3% respectively. There was no clinical factor affecting the PPV for BWBS. Among the imaging factors ipsilateral location of the synchronous lesion to the index lesion (p=0.06) showed marginal statistical significance for synchronous breast lesion to be malignant. Mass with calcification mammography presentation (p <0.01), presence of calcification among the ultrasonography findings (p <0.01) and high BI-RADS final assessment (p<0.01) were imaging factors of the additional synchronous lesion with statistical significance for the synchronous lesion to be malignant.Conclusions: BWBS can be a useful adjunct to mammography for detection of additional synchronous malignancy at the diagnosis of breast cancer with a relatively high PPV, especially when mammography findings are correlated with sonography findings.