الفهرس 
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Abstract
English summary
Breast is hormone sensitive and it is under the effect of the regulatory hormones. Benign breast diseases are commonly presenting in female in the age of reproduction and expected to be hormonally induced, they include a wide range of clinical and pathological abnormalities and they are very common and one third of females are complaining of these diseases in one time of the life. They are sub divided into non-proliferative lesions, proliferative lesions with atypia and proliferative breast lesions without atypia. Most frequent clinical presentations of benign breast diseases are; breast masse, breast pain and nipple discharge.
Triple assessment test includes clinical examination, radiological imaging and pathological examination is a standard approach in assessment of all diseases of the breast, attaining early and correct diagnosis, it gives approximately 100% accuracy rate in case of all components are concordant, but in case of non-concordant test, the needle biopsy represents a single most accurate component. It provides a reliable guidance for management of all breast diseases.
In clinical examination, it is essential to take a holistic approach that includes a full history and a full clinical examination including general examination, local examination of both breasts, both axillae, examination of cervical, supraclavicular and infraclavicular LNs.
Clinical examination of breast lesion in general is less accurate than mammogram. Mammogram has more sensitivity and specificity in palpable breast mass diagnosis when compared to clinical examination, but histo-pathological examination (tru-cut needle biopsy) is required for confirmation of the diagnosis.
Clinical examination and mammography are considered complementary and not competing tools. In some cases, no correlation is presented between the appearance of the breast parenchyma on mammogram and the clinical examination. The firm to hard tissue identified by clinical examination may be a tight packed breast fat as appeared by mammogram. On the other hand, the soft, smooth breast tissue on clinical examination may be visualized dense on mammogram.
The combined use of ultrasound and mammogram for identification of breast lesions has a higher specificity. US is better in evaluation of; cystic breast lesion, duct-ectasia, breast infection and inflammatory breast lesions, it is also better during pregnancy and lactation and in assessment of dense breast, while mammogram is better in identification of breast micro-calcifications, spiculated masse for early discovering of occult breast cancer and for taking of a stereotactic biopsy. Breast MRI is used when there is indeterminate lesions found on mammogram and US, but it can’t replace the requirement for tru-cut biopsy,
Advancement in US technology includes; harmonic imaging, compound imaging power and color Doppler, faster frame rates, higher resolution transducers and more recently elastography and three-dimensional (3D) US that lead to an increase in the accuracy of ultrasonography in diagnosis.
Ultrasound and mammogram do not replace each other, but in suggestion of a single tool, ultrasound is better in younger females and BIRAD 1, 2 & 3 lesions. While, mammogram is better in older females and BIRAD 4 & 5 lesions, however, sono-mammography combination is the best, as it provides a better results than using of a single modality.