 Good morning to everyone. My paper presentation is combined mammographic and sonographic evaluation of palpable breast masses. And my co-authors are Dr. Pradeep Kumar, M.D.R.D. Krukset and Dr. Panil Kumar, M.D.R.D. Krukset. Coming to introduction, breast cancer is the leading cause of non-preventable cancer death among the women, and the palpable mass in the women breast represents a potentially serious lesion and requires evaluation by history-taking, physical examination and mammography. Mammography is a well-defined and widely accepted technique to evaluate the clinically suspected breast regions and screening for breast cancer. In these patients, sonography is a useful adjuvant modality and helps in characterizing a mammographically detected palpable abnormality, especially in patients with dense breast. And the sensitivity and specificity of sonography and mammography is higher if sonography and mammography are combined. The aims and objectives are to evaluate the role of combined mammographic and sonographic imaging in patients with palpable abnormalities of breast and to provide the systematic and practical approach to imaging evaluation of palpable breast masses and then evaluate its image characteristics which helps in decision-making by clinician as to go for biopsy or lesion follow-up. The source of data is collected from the Department of Radiology-Sandhra Medical College, Nizal. Over a period of 18 months, 50 patients aged 30 or above with palpable abnormalities of breast underwent combined mammographic and sonographic evaluation. The inclusion criteria includes women with more than or equal to 30 years referred to the center with palpable abnormalities of breast and the exclusion criteria is women less than 30 years of age with palpable abnormalities of breast and the women with fungating mass per breast and mass adherent to chest wall where performing mammography was difficult. Mammography is performed with GE Sonograph 800 equipment and the sonography is performed with 70 megahertz transducer of senile strain. Coming to the results and analysis, there were 50 patients with palpable abnormalities of breast who underwent combined mammographic and sonographic evaluation. The palpable abnormalities were reported in 29 patients in right breast and 19 patients in left breast and two patients on both sides. This is a table one showing the age distribution of patients in the study group. Since the persons with palpable abnormalities were in the age group of 30 to 39 and 15 were 40 to 49 and 6 were 50 to 59 and 4 patients more than 60. The 33 palpable abnormalities are the palpable lungs and 6 show palpable thickening and 6 nodulity and 5 are non-stress life. And table 3 is the mammographic tissue density in the patient's study. 25% of the patients with palpable abnormalities show scattered fibrogramma density. 50 patients predominantly fatty paranormal density and the 3 palpable abnormalities were heterogeneously dense and the 2 were dense. This is a final assessment of a combined mammographic and sonographic evaluation of palpable abnormalities. The emerging findings were negative in 23 palpable abnormalities and benign in 20 palpable abnormalities and suspicious in 7 palpable abnormalities. Out of the 20 palpable abnormalities, 2 were well benesist, 4 were fibroadnomar, 2 were well deductive tissue and 1 fat microcosm and 1 fibrocystic disease. Table 6 is showing the sensitivity, the specificity caused to a negative predictive value. The sensitivity is 100%. Specificity is 84.3% and positive predictive value is 28.5% and negative is 100%. Out of the 20 palpable abnormalities were benign assessment and 12 benign lesions were visible on both mammography and sonography. 7 of the 20 benign lesions were mammographically occult and agenfitted sonographic evaluation. One lesion was sonographically occult and visualized on mammography. In 7 of the 50 cases the imaging evaluation resulted in suspicious assessment and all of this underwent biopsy and 2 were diagnosed having malignancy. 23 of the 50 palpable abnormalities have negative imaging assessment findings. Of these 9 patients underwent biopsy and have benign findings, the sensitivity and negative predictive value for combined mammographic and sonographic assessment is 100% and the specificity was 80.1%. This is a case showing a calcified non-lil consistent with fibroadnomar on mammography and this is the overall solid lesion with the posterior acoustic enhancement which is the case of fibroadnomar. This is a well-defined homogenous mass lesion on mammogram which is confirmed with sonography as benign cysts. Here we can see the speculated dense mass lesion in the retro-areolar region which is the malignant mass. Here we can see multiple well-defined mass lesions on mammography and now there is one of the same patients showing multiple cystic lesion which is consistent with fibrocystic disease. Here we can see the speculated mass lesion characterized as high probability of malignancy confirmed with biopsy as malignant mass. Here we can see the gene fibroadnomar. Discussion, breast carcinoma has been reported in 4% of the patients with breast symptoms and even among the palpable lesions undergoing biopsy. A large number of lesions turned out to be benign. The role of mammography in patients with palpable breast lumps is of benign cause of palpable abnormality and to avoid the further intervention to support the earlier intervention for a mass with malignant features screen the reminder of the ipsilateral and contralateral breast for original lesions and to assess the extent of malignancy when cancer is diagnosed. In this study, 20 of the 50 lesions were characterized as benign after a combined mammographic and sonographic evaluation clearly showing the value of imaging in helping avoid unnecessary biopsies. Sonography is complementary to mammography in patients with palpable abnormality. Its superiority over mammography in being able to show lesions substituted by dense breast tissue and characterizing the palpable lesions that were sonographically visible or affected. Mammography is complementary to sonography because of its ability to screen the reminder of the ipsilateral and contralateral breast for clinically occult lesions. It has been reported that accuracy of sonography is comparable with that of mammography as a spinning modality for breast cancer. However, the role of sonographic screening for additional lesions in symptomatic patients has been has not been recorded. Conclusion, the combined use of mammography and sonography plays an important role in management of palpable breast regions. The application sought characterizes palpable mass lesion, avoid unnecessary interventions in which imaging findings were unecohocally benign. The negative findings on combined mammographic and sonographic imaging have very high specificity and they are reassuring to the patient. And these are my following references. Thank you.