DIAGNOSTIC ACCURACY OF MAMMOGRAPHY IN CORRELATION WITH ULTRASOUND FOR BREAST CANCER DETECTION IN YOUNG FEMALES WITH POSITIVE FAMILY HISTORY OF BREAST CANCER: USING HISTOPATHOLOGY AS GOLD STANDARD

Background: Breast cancer is the most common malignancy among women worldwide and a major cause of mortality, particularly in Asian populations. Timely and accurate diagnosis of breast masses plays a critical role in guiding effective treatment and reducing disease burden. Mammography and ultrasonography are widely used imaging modalities for early detection, yet their diagnostic accuracy may vary in younger women with denser breast tissue. Histopathology remains the gold standard for distinguishing benign from malignant breast lesions, but it is invasive and resource-intensive. Objective: This study aimed to evaluate and compare the diagnostic accuracy of mammography and ultrasonography in detecting breast cancer in young females with a positive family history, using histopathology as the gold standard. Methods: A comparative accuracy study was conducted at the Armed Forces Institute of Radiology and Imaging (AFIRI), Rawalpindi, from December 2023 to June 2024. A total of 125 females aged 15–45 years, with positive family history and presenting with palpable breast masses, were included. All participants underwent mammography and ultrasonography, followed by core needle biopsy for histopathological confirmation. Imaging findings were classified using BI-RADS criteria. Data were analyzed using SPSS v25.0 and OpenEpi 1.0 to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy. Results: The mean age of patients was 35.14 ± 6.14 years (range: 17–44) and mean tumor size was 14.69 ± 12.08 mm (range: 1.50–59.60). Mammography demonstrated sensitivity of 96.43%, specificity of 100%, PPV of 100%, NPV of 97.18%, and diagnostic accuracy of 98.40%. Ultrasound showed sensitivity of 98.21%, specificity of 100%, PPV of 100%, NPV of 98.57%, and accuracy of 99.20%. Receiver-operating characteristic (ROC) analysis revealed area under the curve (AUC) values of 0.98 for mammography and 0.99 for ultrasound, with a standard error of 0.01 for both. Conclusion: Both mammography and ultrasound demonstrated excellent diagnostic performance in distinguishing benign from malignant breast masses. Ultrasound offers additional advantages as a safe, economical, and non-invasive modality, making it particularly suitable in resource-limited settings.