Diagnostic Accuracy of Sonomammography in Differentiation of BI-RADS 4 Suspicious Breast Lesions as Benign or Malignant Keeping Histopathology as Gold Standard

Diagnostic Accuracy of Sono mammography for BI-RADS 4 Breast Lesions

Abstract

Background: Breast cancer is the most common malignancy among females worldwide, with about 2.3million new cases and about 685,000 fatalities documented in the year 2020. Pakistan, with 220 million, reported 178,000 new cases and 117,149 fatalities. Early detection of breast cancer plays a key role in its survival outcomes. Mammography is a standard screening tool, but sonomammography, being a radiation-free modality, has better diagnostic efficacy in characterizing lesions in dense breasts. Objective: To assess the diagnostic accuracy of sonomammography in distinguishing benign from malignant lesions in all BI-RADS 4 cases, with histopathology serving as the gold standard. Study Design: Cross-sectional study. Settings: Radiology Department of CMH, Lahore Pakistan. Duration: 01-03-2025 to 31-08-2025. Methods: 360 women aged 30-70 years who presented with BI-RADS 4 breast lesions. All subjects underwent an ultrasound, followed by an ultrasound-guided core biopsy. The sonographic results were classified as low (4A) or moderate/high (4B/4C) suspicion. Results: Malignancy was confirmed in 218 of 360 patients (60.6%). Sonomammography detected 207 malignant and 128 benign lesions, yielding 11 false negatives and 14 false positives. It shows sensitivity of 95.0%, specificity of 90.1%, PPV of 93.7% and NPV of 92.1% with overall diagnostic accuracy of 93.1%. These results highlight strong agreement between sonographic and histopathologic findings, supporting sonomammography’s value in lesion stratification. Conclusion: Sonomammography has an excellent diagnostic performance for BI-RADS 4 lesions, especially in dense breasts, and it can help in reducing unnecessary biopsies.