Ultrasound is now better than mammography for the detection of invasive breast cancer.

OBJECTIVE: This study investigated the use of ultrasound (US) as a first-line diagnostic tool. METHODS: All women attending our breast center underwent bilateral whole-breast US in addition to all other investigations, and results were documented prospectively and preoperatively. RESULTS: Of 796 patients with breast cancer, US was positive in 710 (89%) and mammography in 706 (89%) (P = not significant). Either US or mammogram was positive in 770 (97%). Of 537 (67%) symptomatic patients, US was positive in 497 (93%) and mammography in 465 (87%). Either US or mammography was positive in 515 (96%). Of 259 (33%) screening patients, 220 (85%) had invasive cancer. US was positive in 195 (89%) and mammography in 203 (92%) (P = not significant). Either US or mammography was positive in 217 (99%). Of 39 screening patients with ductal carcinoma in situ (5% of all patients), US was positive in 18 (46%) and mammography in 38 (97%). CONCLUSIONS: US is significantly better than mammography for detecting invasive breast cancer (92% patients). The combination of US and mammography is significantly better than either modality used alone, together resulting in 9% more breast cancers detected.

Combined image guidance excision of non-palpable breast lesions.

When mammogramography detects a non-palpable lesion the surgeons may be called upon to establish a diagnosis. Various techniques are currently employed. We describe a technique, which can be used both for diagnostic and for therapeutic procedures. The technique essentially involves localising the tip of a guide-wire, placed under mammographic guidance, with ultrasound scanning. This minimises many of the problems encountered with wire guided excision. We conducted a prospective non-randomised study using our combined image guidance technique (CIG) for patients undergoing diagnostic (n = 24) and therapeutic biopsy (n = 13). We found that significantly smaller diagnostic biopsy weights were achievable using CIG, compared to non-CIG techniques. Reduced biopsy weights are recommended by current guidelines.