EP37.02: Sonography as an adjunct to mammography in asymmetric retroareolar density Article Swipe
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· 2019
· Open Access
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· DOI: https://doi.org/10.1002/uog.21856
· OA: W2978002002
Retroareolar region refers to the region within two cm from the nipple and/or involves the nipple-areolar complex on mammogram (Giess et al., 1998). While almost 8% of breast cancers occur in this region, mammography is less sensitive in retroareolar areas relative to other areas in breast and ultrasound maybe a useful adjunct. In this study, we evaluated the spectrum of mammographic asymmetric retroareolar density with sonography and its role as an additional modality. We included 44 patients with asymmetric retroareolar density present on one side only on mammography, in this study. The asymmetric density was graded as - grade 1: same density as equal volume of fibroglandular tissue; grade 2: asymmetric higher density than equal volume of fibroglandular tissue; grade 3: asymmetric density with definite lesion. Sonography using proper scanning technique with compression and ballottement maneuver as necessary was done in all cases. Pathological diagnosis was taken as gold standard. Simple statistical techniques were used for analysis. The mean age of patients was 46.39 years, range being 27- 69. Most of the mammograms showed grade 2 asymmetry, of which almost 85% had benign disease like cysts and mastitis. All patients with grade 1 density were benign, most being normal fibroglandular tissue. Six of the nine patients with grade 3 density had malignant cause while remaining had inflammatory disease. Associated finding nipple retraction was present in five of nine patients with malignant mass. Final histopathology showed 80% lesions were benign. Sonography helped to increase the confidence of probably benign lesions in mammography to benign in 16 of 35 benign cases, thus, decreasing patient anxiety. It also suggested higher likelihood of malignancy in two of the nine malignant cases compared to mammogram. Mild asymmetric density on mammography usually have a benign etiology which can be confirmed with sonography and safely followed up. Asymmetry with ancillary findings suggests the need for a biopsy to confirm the pathology.
