Evaluation of Clinical Assessment, Mammography, and Ultrasonography in Diagnosis of Benign and Malignant Breast Lesions and Determining Their Cost-Effectiveness

Background: In order to evaluate the diagnostic capabilities of various methods of breast cancer, it was expected that the use of non-invasive imaging techniques would be the earliest and the best technique of patient management. Objectives: We attempted to evaluate mammography and ultrasonography reports along with clinical diagnosis and their agreement with the definite diagnosis of breast lesions by pathology report. Methods: This cross sectional study was conducted on 287 women, who were referred to the cancer research center and breast clinic in Tehran between August 2016 and September 2017. The patients’ basic information and their history were asked and recorded on the checklist. Also, the information obtained from the imaging report as well as the results of the pathological assessment were extracted. Results: Compared with the pathological evaluation, the clinical assessment showed a sensitivity of 89.7%, a positive predictive value (PPV) of 97.6%, and a diagnostic accuracy of 90.24% in differentiation between malignant and non-malignant lesions. And specificity of 51.6%, and negative predictive value (NPV) of 89.2%, and a diagnostic accuracy 87.8% in differentiation between non-benign and benign lesions. Mammography had a sensitivity of 24.7%, PPV of 100%, and an accuracy of 40.2% in differentiation between malignant and non-malignant lesions. And specificity of 82.0%, NPV of 31.1%, and an accuracy of 59.0% in differentiation between non-benign and benign lesions. Ultrasonography had a sensitivity of 26%, PPV of 100%, and an accuracy of 41.44% in differentiation between malignant and non-malignant lesions. And specificity of 58.2%, NPV of 53.3%, and an accuracy of 80.6% in differentiation between non-benign and benign lesions. The cost for correct diagnosis ratio was estimated 12.31 Dollars in clinical assessment, 109.66 Dollars in mammography assessment, and 122.32 Dollars for the assessment with ultrasonography. Conclusions: We deduced that clinical assessment was in line with pathology finding in comparison to mammography and ultrasonography in differentiation between malignant and benign lesions. In conclusion, we suggest that every radiologist pass more specialized training for reporting the mammography and ultrasonography images for declining false negative and positive results.