[The use of echography and US-guided percutaneous puncture in addition to mammography for the detection of malignant breast tumors].

At present, mammography is the most effective means to detect breast cancers, especially in the early stages. However, it lacks sensitivity and specificity in women with dense breasts. Moreover, indeterminate lesions are often seen on mammograms, which should undergo further examination before surgery. Due to recent improvement in the technique--i.e., the use of high-resolution 10-MHz transducers--US can now detect also nonpalpable breast lesions, about 1 cm phi. Fine-needle biopsy (FNB) under US guidance, which is complementary to US, allows a correct diagnosis of malignancy in a high number of cases. A total of 1821 women with indeterminate lesions at mammography underwent US, and 491 of them underwent US-guided FNB, in the Leno Hospital (Brescia, Italy), in the period 1988-90. Thirty-one breast cancers which had been missed at mammography and clinical examination were found. Three cases were carcinomas in situ, 23 invasive cancers were classified as pathological stage T1, and 15 cases had no axillary lymph node involvement. The routine use of US and FNB in addition to mammography when indeterminate lesions are seen on mammograms and in women with dense breasts may significantly reduce the number of both false-negative cases at mammography and unnecessary biopsies.