 Good afternoon, everyone. I'm Dr. Faisal Sheikh, junior resident of department of radio diagnosis at MG Medical College, Navi, Mumbai, and the topic of my paper presentation is diagnostic value of screening mammography and subsequent ultrasound correlation of non palpable breast lesions in asymptomatic women. The aims of my study are as follows. That is, if timely breast screening by mammography is capable of detecting suspicious lesions pertaining to breast cancer in asymptomatic women who are in the age group of 40 to 59 years with no increased risk of breast cancer to assess these findings and give by that final assessment categories, which are going to be based on initial mammographic and subsequent sonographic evaluations. To make suitable decisions regarding interventions and follow up based on the sonographic findings and to give final by that assessment categories. We all know that breast cancer is the leading cancer in women worldwide in both developed as well as developing countries and the fifth most common cause of death due to cancer in the general population. The annual incidence of breast cancer varies widely worldwide. Although the rates are higher in developed countries and recent years, this cancer incidence has also increased in developing countries. Early detection of breast cancer comprises of two main strategies like the screening and early diagnosis. Because the early detection of breast cancer before there's a palpable new you increase the chances of survival routine mammography screening and physical examination are recommended. In the age group of 40 to 49 years, breast cancer incidence is lower than that of patients who are in the age group of 50 to 59 years. However, the occurrence of dense breast and fast growing tumors is higher. Breast cancers are biologically more aggressive in young women with more frequent adverse sister bathological characteristics and worse progress since then older women. The objective of this study is to assess the mammographic findings in women who are in the age group of 40 to 59 years with no increased risk of breast cancer and to compare these findings with ultrasound and give final by that assessment categories in order to guide suitable interventions. So, we had a total of 545 women who spend the age group of 40 to 59 years who underwent mammography screening between November 2020 and April 2021 which were included in our study. Women with breast related complaints like pain, nipple discharge or positive physical findings like shrinkage, bulging, nodules, hardening. They excluded along with those at high risk of breast cancer. Women with the following characteristics were considered to be at high risk of breast cancer. That is, who had an early age at onset of menar, late age at onset of menopause, a first full term pregnancy after the age of 30 years, tiny history of pre menopause breast cancer in first degree relatives and a personal history of breast cancer or benign proliferative breast disease. So, for each patient, a detailed history was taken which included all these factors, age at first childbearing, age at menar, age at menopause, history of breastfeeding, number of children, history of hormonal therapy, history of pre menopause breast cancer amongst first degree relatives, personal history of breast cancer, benign proliferative breast disease as well as radiation, chemical exposure and smoking, if any. A detailed analysis was conducted which comprised of mammography, ultrasound of breast and histopathological examination, wherever indicated. So, he had conventional film screen mammography being performed with at least two views per breast, that is mediolateral oblique and craniocordial. Additional views or spot compensation views were often wherever appropriate. He had the breast density grading determined and reported according to the latest ACR by that static breeze. Ultrasonic examinations were henceforth performed using the high resolution unit, the linear array probe. All ultrasound examinations were performed with the patient in supine position for the medial parts of the breast and in the contralateral posterior oblique position with the arms raised for the lateral parts of the breast and hence he scanned the whole breast. Sonographic and mammographic findings were then assessed and reported according to the latest ACR by that's that is breast imaging, reporting and data system categories. Then he categorized women in category four categories, that is A, B, C and D. We had 117 patients in category A, whose breast was almost entirely fatty. We had 155 patients under category B, whose breast panchama had scattered areas of fibro glandular density. 135 patients under category C, whose breast panchama were heterogeneously dense and 138 patients under category D, whose breast panchama were extremely dense. So these are the images of the patients who were included in our study. As you can see in the first image that we have almost entirely fatty breast panchama falling under ACR by that's category A. We had a breast panchama that we had scattered areas of fibro glandular density falling under ACR by that's category two D. We had heterogeneously dense breast panchama falling under ACR by that's category C and extremely dense breast panchama falling under ACR by that's category D. So these are some of the cases from amongst the total 545 women which were included in our study. Here we have a 56 years old female patient and whose mammography findings had both the breast distinct scattered areas of fibro glandular density which limits mammographic evaluation which came under ACR category B. No other mass lesion, microcalcification, asymmetric areas or architectural distortion was seen. The skin subcutaneous tissue nipple adiola complex appeared normal with no significant actual lymphedinopathy. This is the manner in which we reported our mammography findings. Then on ultrasound we had a 1.4 centimeter sized well circumscribed any quick oval parallel mass with imperceptible walls, marked posterior caustic enhancement and with no evidence of internal and peripheral vascularity on color of the study. So our final impression was that of a simple breast cyst and this came under ACR by that's category two of that is the benign category. This is how we reported our ultrasound findings. Next, we had a 42 years old female patient which was best displayed extremely dense breast venchyma which limits mammographic evaluation and this came under ACR category B. No other mass lesion, microcalcification, asymmetric areas or architectural distortion was seen on mammography. Then on ultrasound we had prominent fibro planter architecture which was noted bilaterally, however, no discernible mass was noted. No evidence of any calcification nipple retraction or skin thickening and hence the final diagnosis was fibrocystic changes or fibriery noses which and hence we gave a final category of three according to the ACR by that system. Then we had a 52 years old female patient whose breast displayed extremely dense breast venchyma which limited mammographic evaluation and this we placed in the ACR category B. On mammography we also saw large encapsulated mass in the upper quadrant as can be seen by data heads containing both fat and glandular elements giving a breast within a breast or the cut sausage appearance. No other features of microcalcification asymmetric areas or architectural distortion was seen with the skin subcutaneous tissue and nipple alia complex also appear normal and no significant acetyl lymphedinopathy was seen. On ultrasound heteroacryglation presenting glandular and fat components with a thin ecogenic pseudo capsule which was suggested of a fibroidenolipopathy. Pathology was then confirmed by an anthropological examination and we gave the final diagnosis of fibroidenolipoma or haematoma and this came in the ACR by its category two that is the benign category. So a total of 22 resolutions out of 545 total asymptomatic subjects examined and psychological examination the final aspiration was indicated for patients with barats category four and five. Final histological diagnosis was obtained and all cases were verified by reviewing the histopathological report and hence the histopathology results revealed the presence of a total of 19 invasive death cancers and 526 benign lesions. So these are the results from our study where we had a total of 545 asymptomatic women in the age group of 40 to 59 years who were screened by mammography and subsequent ultrasound which revealed the presence of 19 invasive death cancers and 526 benign lesions. We had a total of 8 patients with invasive ductile total of 7 patients with invasive lobular one patient with mixed type of cancer one patient with lobular one under medullary and one with mucous carcinoma. So we see that we have maximum number of patients with invasive ductile type of breast carcinoma. This is a final by that assessment category scoring system where we had zero patients under category zero. We had a total of 210 patients under category one of negative and hence a further management was routine mammography screening. We had a total of 297 patients with category two of benign finding and this and the further management for this category was routine mammography screening. We had a total of 16 patients under category three that is probably benign where we had further management by short interval follow that is six months of continuum surveillance mammography. We had total of three patients under category 4A that is having a low suspicion for malignancy. However, a further management was tissue diagnosis for these patients. We had zero patients under category 4B and 4C that is moderate suspicion for malignancy and high suspicion for malignancy respectively. We had a total of 19 patients under category five which is highly suggestive of malignancy and hence further management comprised of tissue diagnosis and we had zero patients under category six that is more likely to be malignancy. So from our study we find that screening mammography is therefore recommended every one to two years for women once they reach 40 years of age and every year once they reach 50 years of age. Screening is usually cost effective and justified when the disease burden is relatively high and adequate health system capacity has been achieved and then the quality of the entire multidisciplinary screening process is assured. In patients with dense breast tissue, we find that ultrasound is capable of raising sensitivity for the detection of breast cancer especially for Asia barats category C and D of dense breast men's climber. In the case of a patient without any symptoms, breast ultrasound is the highest sensitivity for detecting breast cancer in women with dense breast tissue, women under the age of 50 years and high risk women. So out of 545 asymptomatic women, our study had 177 with category A, 155 with category B, 135 with category C and 148 with category D breast men's climber as per the Asia barats category system. So we see that we have a number of patients with category A that is almost entirely fatty breast men's climber and the least comes under category C that is heterogeneously dense breast men's climber. Our study also revealed a total of 19 barats 5 lesions which were highly suggestive of malignancy and 3 barats 4 lesions which was suspicious for malignancy. This is to pathological confirmation obtained among these asymptomatic women with no risk factors of breast cancer. A total of 297 barats 2 lesions of benign category and 65 barats C lesions of probably benign categories we discovered from our study. These are my references. I've taken reference from effectiveness of mammography screening in reducing breast cancer mortality in women aged 39 to 49 years of meta-analysis. Also, I see three of mammographic screening in women from age 40, results of screening in the first 10 years by Morris, Thomas, Evans and Thomas. Risk of radiation induced breast cancer for mammography screening by YAP and solid breast node use, use of sonography to distinguish between benign and malignal lesions that stab jaws, thick men that dense. Thank you very much for this opportunity.