A team led by Dr. Olivia Linden of the University of California, San Francisco (UCSF) conducted a study that included 323 cases of women with palpable symptoms evaluated with diagnostic mammography between 2009 and 2017; their breast tissue had been categorized as "almost entirely fatty" (AJR, April 2020, Vol. 214:4, pp. 754-760).
The researchers reviewed clinical, imaging, and pathologic results for each case. Of the 323 cases, 91% had also undergone ultrasound.
At mammography, the group found the following:
- 74% of cases had no correlate to the palpable lump.
- 12% had a benign correlate to the palpable lump.
- 14% had a suspicious correlate to the palpable lump.
The researchers found a total of 48 positive mammography cases. Of these, 27 (56%) were malignant. Mammography found all the cases except one, which was identified by ultrasound; the group noted that this one case was from a woman who actually did not have almost entirely fatty breast density.
Mammography alone in this particular breast density category had a negative predictive value of 99.6%, a sensitivity of 96%, and a specificity of 93%.
"In patients with almost entirely fatty breast tissue presenting with palpable symptoms, mammography alone had a high sensitivity and specificity," the group concluded. "Our results support that mammography alone may be sufficient for evaluation of palpable symptoms in these women as long as density criteria are strictly applied."
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