Abstract

Abstract
Background: Breast cancer is the leading cause of cancer-related mortality among women worldwide. In Tanzania, most patients present at advanced stages due to limited screening programs.
Objectives: To evaluate the diagnostic accuracy of mammography and assess the correlation between mammographic features, BI-RADS categories, and histopathological findings among women suspected of breast cancer at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania.
Methods: A retrospective analytical study was conducted between January 2019 and December 2024. All mammograms were independently interpreted by two consultant radiologists, with consensus reading applied to resolve discrepancies. BI-RADS 5th edition was used without prior knowledge of biopsy results. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy. Associations between mammographic features and histopathology were analyzed using logistic regression.
Results: A total of 255 patients were included. Of these, 138 were confirmed malignant on histopathology. Mammography achieved an overall accuracy of 80.3%, with sensitivity of 83.2%, specificity of 77.8%, PPV of 81.4%, and NPV of 79.8%. BI-RADS 5 lesions were associated with 100% malignancy. Spiculated margins, architectural distortion, and skin thickening were strongly predictive of malignancy, while clinical symptoms such as breast pain and nipple discharge showed limited diagnostic relevance.
Conclusion: Mammography at KCMC demonstrated good diagnostic accuracy and reliable risk stratification using BI-RADS. Spiculated margins, irregular shapes, and architectural distortion were strongly linked to malignancy. These findings support mammography as a cornerstone of early breast cancer detection in Tanzania and underscore the need to expand screening programs.

Key words: Mammography, Breast Cancer, BI-RADS, Diagnostic Accuracy, Tanzania