DIAGNOSTIC ACCURACY OF SONOMAMMOGRAPHY IN DIAGNOSIS OF SUSPICIOUS BREAST LESIONS KEEPING HISTOPATHOLOGY AS GOLD STANDARD IN PAKISTANI WOMEN UNDER 35 YEARS

Background: Breast cancer is the most prevalent malignancy among women worldwide and constitutes a significant public health burden in Pakistan, where approximately 90,000 new cases are reported annually. Its incidence among women under 35 years is particularly concerning, as mammography has reduced diagnostic sensitivity in this age group due to dense breast tissue. Sonomammography provides a safe, accessible, and radiation-free imaging alternative, yet its diagnostic accuracy in younger women requires further validation to guide clinical decision-making and improve early detection strategies. Objective: To determine the diagnostic accuracy of sonomammography in detecting breast lesions in women under 35 years, using histopathology as the reference standard. Methods: An observational cross-sectional study was conducted at the Cancer Care Hospital and Research Centre, Lahore, over a six-month period. A total of 89 female participants younger than 35 years, presenting with breast-related symptoms, were enrolled through non-probability purposive sampling. Sonomammography was performed using Toshiba Xario 100G ultrasound with a high-frequency linear transducer (6–14 MHz). Suspicious lesions identified on ultrasound were subjected to ultrasound-guided core needle biopsy, with histopathology serving as the gold standard. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall agreement. Data were analyzed using SPSS version 29. Results: Histopathological evaluation confirmed 54 malignant and 35 benign lesions. Sonomammography demonstrated a sensitivity of 87.9%, specificity of 82.8%, PPV of 87.9%, and NPV of 82.8%. Agreement between ultrasound and histopathology was observed in 70.7% of cases, with a statistically significant association (χ² = 16.83, p = 0.001). The majority of malignant lesions were characterized by irregular shape (67.4%), ill-defined margins (52.8%), and hypoechoic echotexture (64.0%). Conclusion: Sonomammography proved to be a reliable diagnostic tool in evaluating breast lesions among young Pakistani women, demonstrating strong concordance with histopathology. Its high sensitivity and specificity emphasize its role as a practical alternative to mammography, particularly in resource-limited healthcare settings.