الفهرس 
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Abstract
This study was carried out on one hundred patients with clinical findings suggestive of breast disease. Histopathological examination was done for all patients. Sixty-one patients had benign mastopathies and thirty-nine had malignant mastopathies. The age of the examined patients ranged from sixteen to eighty years.
According to mammographic findings, the pattern of breast parenchyma was classified into dense, semidense and fatty.
Risk factors like early menarche, late menopause, positive family history and mastectomy on one side correlated with incidence of malignant lesions.
The clinical presentation included breast lump, nipple discharge, mastalgia, skin changes, enlarged axillary lymph nodes and combination of these symptoms.
Thirty-one (79.48%) malignant lesions showed stellate mammographic margins, The welldefined margins were seen in fifty one benign lesions (83.6%)
The upper outer breast quadrant was the most common quadrant that showed either benign (80.3%) malignant mastopathies (79.4%)
The patters of calcifications encountered in mammography were punctate, branching, patchy, marginal and dusty. Malignant microcalcifications less than 0.5 mm in diameter could be the only sign of malignancy.
Ultrasound showed many diagnostic criteria to differentiate benign from malignant lesions as shape, border, boundary echoes, internal echoes, posterior echoes, lateral echoes and depth/width ratio.
Ultrasound study for enlarged axillary lymph nodes revealed many important criteria for benignity and malignancy as regards the lymph node cortex, hilum, shape and size.
Dense breast pattern was responsible for obscuring eight malignant lesions (12.8%) and eight benign lesions (16.2%).
Sonomammography showed the highest diagnostic efficacy; 94.9% compared to X-ray mammography, which showed 90% efficacy.
The sensitivity of mammography alone in diagnosing breast lesions was 76.9% with specificity 98.4% (efficacy 90.0%). Sonomammography was found to have the highest diagnostic accuracy. Combining mammography to ultrasonography resulted in 94.9% sensitivity to diagnose lesions with specificity 100% (efficacy 98%).
Positive predictive value and negative predictive values for mammography alone was 96.8% and 87% respectively while in combining mammography to ultrasonography it was 100% and 96.8% respectively.
Conclusions:
- Risk factors for cancer breast includes :
Early menarche, late menopause, positive family history and mastectomy on one side. Women found to have an increased risk of breast cancer should be counseled about options for management, including close surveillance, life style modifications and chemoprevention.
- The margin of different breast lesions helps in the differential diagnosis of benignity and malignancy.
- The upper outer quadrant is the commonest site for benign and malignant mastopathies.
- Microcalcifications is the considered to be an important sign of malignancy and it could be the only sign of malignancy. Malignant microcalcifications present in clusters and exhibit a dusty, patchy, punctuate or branching appearance. Malignant microcalcifications are less than 0.5 mm in diameter. Benign macrocalcification are usually larger than 0.5mm with a rounded coarse or marginal appearance.
- The only benign lesion that showed microcalcification was the fibrocystic disease of the breast.
- Malignant breast masses usually show spiculated and irregular outlines while benign masses are usually regular rounded or oblong in shape.
- Interpretative criteria for breast lesions by ultrasound include: posterior shadowing or enhancement, laterals echoes, internal echoes, shape and borders of the lesion.
- Most malignant lesions showed a high depth/width ratio while most of the benign masses showed small depth/width ratio.
- Sonomammography can diagnose enlarged axillary lymph nodes. It can discriminate between benign and malignant nodes. Malignant nodes usually shows absent or narrow hilum with cortical thickening, rounded shape and usually of large sizes while benign nodes shows wide hilum, thin cortex oblong shape and smaller size.
- Ultrasound detected 15.38% false negative cancer by mammography. This indicates that breast ultrasound should be further supplemented after mammography.
- Ultrasound is essential in dense breast evaluation. The difference in diagnosis between mammography and breast ultrasonography was found in the dense breast variety.
- Sonomammography showed the highest diagnostic accuracy for cystic breast lesions and ductectasia.