Role of Mammography and Ultrasound in Non- palpable lesions of the Breast presenting with Mastalgia and Nipple Discharge

Objectives: This article aims to assess the diagnostic value of mammography and ultrasound in mastalgia and nipple discharge without any palpable breast mass.Materials and Methods: In this retrospective cross-sectional study, 250 ultrasound-guided biopsies performed for various breast lesions were reviewed and 50 women were included in the study. Mammography and ultrasound features of these lesions were analyzed as per ACR BI-RADS lexicon 5th edition by two radiologists. The lesions were classified as benign or malignant based on histopathology. Results: Out of the 50 cases, 5 [10%] were found to be malignant, and 45 [90%] were found benign. Of these 22 [44%] had mastalgia, 12 [24%] had nipple discharge, and 11 [22%] had both mastalgia and nipple discharge. Malignant lesions more frequently showed segmental distribution of calcifications [3/5, 60%; p= 0.039], increased distance of the lesion from the nipple [mean= 3.7 +/- 2.1; p=0.004], irregular shape [3/5, 60%; p= 0.02], microcalcifications [2/5, 40%, p= 0.028] as compared to benign lesions. The sensitivity and specificity of mammography were 60%, and 68% respectively, and of ultrasound were 100% and 35.6%, respectively. Conclusion: Mammography and ultrasound assessment are reliable in characterizing malignancy in non-palpable breast lesions, with ultrasound being more sensitive and mammography being more specific