 Manchika Nandwani, radio. Good evening everybody. I am Manchika Nandwani, radiology second-year resident from SBKS, MIRC, Vadodara. My topic for paper presentation is evaluation of breast masses using mammography and sonography as first-line investigations. My presenting author is co-author is Dr. Parthiv Brahmbat. Breast diseases are common females in developing countries like India. Females are unaware of breast pathologies and are hesitant to reveal. Hence, they are detected usually in advanced stages, various benign breast regions like fibrodenoma, simple cysts, galactoseals and large lymph nodes and different malignancy pathologies of female breast. It is the most common cause of cancer death in human overall fifth common cause of cancer deaths in world. Delaying detection causes malignancy to progress in advanced stages. Usually it comprises of inoperable masses, mechs and eventually leads to mortality. Case studies, inclusion criteria, all patients with clinically palpable breast masses, usual USG proven solid breast masses or complex cystic lesions. No obvious breast mass on palpation but prominent auxiliary nodes. Females with clinical signs of redness over the breast area, nipple retraction, dryness and altered shape. Known case of carcinoma breast with mastectomy done on one side. Familiar history of breast mass in first degree relatives, exclusion criteria, very large and very tender breast, very apprehensive patient. Various pathologies in breast is fibrodenomas, malignancy, ductectasia, breast abscess, mastitis, perimenopausal fibrocystic changes. Confirmation is by FNAC of biopsy in doubtful cases, postoperative follow-up in operative cases. In cases of simple system galactosyl no histopath confirmation was done, aspiration of cyst was done to confirm. No histopath done in case of normal ultrasound findings and normal mammal in patients complaining of apparent mass, felt on clinical examination. Such patients refused to give consent for invasive histopath study after normal reports and they were labelled as normal. Insensitivity and positive predictive value could not be obtained. Statistical analysis for comparison study was done and p-value was obtained. The value of specificity, negative predictive value accuracy for ultrasound mammal and overall breast masses were obtained when used separately and in combination. Fibrodenoma, clinically patients present with history of freely movable lump in one or both breasts. Since few months to years, usually painless on mammal fibrodenoma shows well-marginated, soft tissue density, radio-picity with or without typical benign type of circumferential concentric calcifications, popcorn type of calcification. Many of fibrodenoma do not show calcification on ultrasound, well-defined round to overlesion with homogenous ecotexture and width created in depth. Malignant masses present clinically with lump in the breast, protracted nipple, pain and bloody discharge, ulceration over the skin. Malignant lesions on mammal reveal irregular mass, piculated or lobulated margins, focal asymmetry. Lesions appear taller than wider, retracted nipple. Calcification may be linear branching, granular clustered with surrounding architectural distortion. Out of 30 diagnosed malignancy, chances of malignancies were higher in older patients than younger patients. Two lesions were missed on mammal and four were missed on USG. One of them was missed for both. For malignancies, specific of mammal is 93% and that of USG is 87%. Case of ductal carcinoma. Cystic lesions present clinically with lump in the breast. On mammal, cystic lesions appear well-defined soft tissue density lesion could not be differentiated from solid masses like fibrodenoma. On ultrasonography, cystic lesion can easily be diagnosed. For cystic lesion, like simple cysts, multiple cysts in perium, when there are causes of fibrocystic changes, galactosilane and ductctasia, ultrasonography is far better than mammography. All the patients with ductctasia were above ears and had complaints of turbid discharge on the nipple. Mammoo in most of the ductctasia patients were labelled as normal mixed pharynchymal pattern, except in one patient, fatty breast was given. Ultrasonography proved to be problem solving in all the cases of ductctasia. Advantages of ultrasonography and limitations of ultrasonography in breast lesions. Advantages are no radiation of exposure, better detection of cystic lesions. It's real time whole breast can be evaluated. Better in infective pathology and tender breast, vascularity can be commented. Limitations, microcalcifications can be missed, fat and air cannot secure the lesion. Intrassistic contents, sensitivities, operator dependent, isoequic and multi-centric lesions can be missed. Well-defined malignant lesion can be mistaken as benign. Discussion, breast masses are common in female and amongst all the breast masses malignant masses are the most feared. Breast cancer is the commonest cancer of cancer mortality in females where breast cancer in men accounts for only 0.7% of all the breast cancers. Patients with palpable breast lesions commonly present for radiological evaluation. Various imaging like Mammoo, USG, MRS, Cinti mammography and PET are now available. Mammoo in breast mass can be used to look for microcalcifications and architectural distortions, speculated margins to determine the potential malignant nature of the lesion, also to screen for occult disease in the surrounding tissue. USG is the perfect adjunct to the mammoo since both the modalities are easily available, relatively cheaper and can take relatively less time. Initially, ultrasonography was only used to differentiate solids from cystic masses. Ultrasonography effectively differentiates solid lesions from cysts which accounts for nearly 25% of breast lesions. Now it can be used to evaluate dense breast usually below 35 years of age and breast when solid lesions and cysts are obscured by Mammoo due to dense fibro-gambular tissue. Ultrasonography helps in diagnosis and to decrease the number of surgical biopsies. It is necessary to evaluate the complex cysts or which need repeated aspirations since they can harbor malignancy. Ultrasonography can be used to differentiate benign from malignant lesions with negative predictive value of 99.5% specificity of 67.8% and overall accuracy of 72.9%. The specific sonographical features you determining the benign nature of the lesion include intense hyper-ecogenicity, ellipsoid shape, gentle lobulation, then ecogenic pseudo-capsule and less than four gentle lobulations. Malignant nature of the lesion is given by speculations, angular margins, shadowing micro-lobulation and micro-calciation. Though a definitive diagnosis is possible with non-invasive imaging procedures, for most lesions, histopath or cytos are proven tools and essential for obtaining confirmed diagnosis. Conclusion, our study confirms the higher combined specificity for ultrasonography and mammographic production of breast masses using including malignancies. USG is better in cystic lesion, it takes less infection and preventive conditions. Pregnancy lactations, dense breast evaluation, real-time image guidance, where MAMO is written in tecton micro-calciations, speculated masses for early collection of occult malignancy for stereotactic biopsies. USG and MAMO cannot replace each other but to suggest single modality, ultrasonography is better in younger populations and bioregics, 1, 2 and 3 lesions, where MAMO is better in older populations and bioregics, 4 and 5, and sonal mammographic correlation is best in both. Extra-breast lesions can mimic breast mass, its awareness and careful cross-sectional imaging can be problem-solving. Here are the references. Thank you.