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European Radiology

, Volume 20, Issue 5, pp 1085–1092 | Cite as

Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures

  • Fritz K. W. SchaeferEmail author
  • A. Waldmann
  • A. Katalinic
  • C. Wefelnberg
  • M. Heller
  • W. Jonat
  • I. Schreer
Breast

Abstract

Purpose

To determine the value of a breast ultrasound (US) examination in addition to mammography in cases of American College of Radiology (ACR) tissue pattern III and IV in symptomatic women and women at risk.

Materials and methods

A prospective cohort was initiated between 2001 and 2005 with a total of 59,514 patients and 102,744 mammograms. Documentation was available for 102,557 diagnostic procedures. Breast US was indicated in all women with ACR III and IV in addition to a suspicious clinical examination and in cases of masses and focal asymmetries in mammography.

Results

In total, 62,006 additional USs were performed, in which 116 mammographically and clinically occult breast cancers were diagnosed (detection rate: 1.9/1,000 examinations), while mammography alone (40,551 examinations) revealed 903 cancers (22.3/1,000). Of all 1,019 breast cancer findings, 12.8% were detected because of the combination of mammography and US. In the group with ACR III/IV, 15.9% of cancers were found by supplemental US compared with mammography alone.

Conclusion

The addition of US to mammography vs. mammography alone resulted in a significant (P < 0.01) increase in breast cancer detection rate.

Keywords

Breast Mammography Ultrasound Expert reading Cancer 

Notes

Acknowledgements

Approximately 250 people (doctors, medical staff, etc.) have now been involved in the QuaMaDi project for more than 5 years (see also www.quamadi.de). They have examined and treated patients, completed case report forms, entered the data into a database, analysed the data and discussed the results. This publication is an acknowledgement of all of them. We also wish to thank the patients for their participation and confidence in the project, the participating health insurance companies for their far-sightedness in financing the QuaMaDi project and the German Cancer Aid for their support. The project was funded by several statutory health insurance companies, the Ministry of Social Affairs and Health and German Cancer Aid.

References

  1. 1.
    Nystrom L, Andersson I, Bjurstam N, Frisell J, Nordenskjold B, Rutqvist LE (2002) Long-term effects of mammography screening: updated overview of the Swedish randomized trials. Lancet 359:909–919CrossRefPubMedGoogle Scholar
  2. 2.
    Shapiro S, Venet W, Strax P, Venet L, Roeser R (1982) Ten- to fourteen-year effect of screening on breast cancer mortality. J Natl Cancer Inst 69:349–355PubMedGoogle Scholar
  3. 3.
    Tabar L, Fagerberg C, Gad A, et al (1985) Reduction in mortality from breast cancer after mass screening with mammography. Randomized trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet 1:829–832CrossRefPubMedGoogle Scholar
  4. 4.
    Roberts MM, Alexander FE, Anderson TJ et al (1990) Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet 335:241–246CrossRefPubMedGoogle Scholar
  5. 5.
    Bird RE, Wallace TW, Yankaskas BC (1992) Analysis of cancers missed at screening mammography. Radiology 184:613–617PubMedGoogle Scholar
  6. 6.
    Holland R, Hendriks JH, Mravunac M (1983) Mammographically occult breast cancer: a pathologic and radiologic study. Cancer 52:1810–1819CrossRefPubMedGoogle Scholar
  7. 7.
    Ma L, Fishell E, Wright B, Hanna W, Allan S, Boyd NF (1992) Case control study factors associated with failure to detect breast cancer by mammography. J Natl Cancer Inst 84:781–785CrossRefPubMedGoogle Scholar
  8. 8.
    American College of Radiology (1998) Illustrated Breast Imaging Reporting and Data System (BI-RADS), 3rd edn. American College of Radiology, Reston, VAGoogle Scholar
  9. 9.
    Kerlikowske K, Ichikawa L, Miglioretti DL et al (2007) Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst 99:386–395CrossRefPubMedGoogle Scholar
  10. 10.
    Boyd NF, Guo M, Martin LJ et al (2007) Mammographic density and the risk and detection of breast cancer. N Engl J Med 356:227–336CrossRefPubMedGoogle Scholar
  11. 11.
    Boyd NF, Lockwood GA, Martin LJ et al (1999) Mammographic densities and risk of breast cancer among subjects with a family history of this disease. J Natl Cancer Inst 91:1404–1408CrossRefPubMedGoogle Scholar
  12. 12.
    Kolb TM, Lichy J, Newhouse JH (1998) Occult cancer in women with dense breasts: detection with screening US – diagnostic yield and tumour characteristics. Radiology 207:191–199PubMedGoogle Scholar
  13. 13.
    Buchberger W, De Koekkoek-Doll P, Springer P, Obrist P, Düsner M (1999) Incidental findings on sonography of the breast: clinical significance and diagnostic workup. AJR Am J Roentgenol 173:921–927PubMedGoogle Scholar
  14. 14.
    Kaplan SS (2001) Clinical utility of bilateral whole breast US in the evaluation of women with dense breast tissue. Radiology 221:641–649CrossRefPubMedGoogle Scholar
  15. 15.
    Katalinic A, Bartel C, Raspe H, Schreer I (2007) Beyond mammography screening: quality assurance in breast cancer diagnosis (the QuaMaDi Project). Br J Cancer 96:157–161CrossRefPubMedGoogle Scholar
  16. 16.
    Gotzsche PC, Olsen O (2000) Is screening for breast cancer with mammography justifiable? Lancet 355:129–134CrossRefPubMedGoogle Scholar
  17. 17.
    Olsen O, Gotzsche PC (2001) Cochrane review on screening for breast cancer with mammography. Lancet 358:1340–1342CrossRefPubMedGoogle Scholar
  18. 18.
    Tabar L, Vitak B, Chen HH, Yen MF, Duffy SW, Smith RA (2001) Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality. Cancer 91:1724–1731CrossRefPubMedGoogle Scholar
  19. 19.
    Gotzsche PC, Nielsen M (2006) Screening for breast cancer with mammography. Cochrane Database Syst Rev 2006:CD 001877. doi: 101002/14651858.CD001877.pub2
  20. 20.
    Kolb TM, Lichy J, Newhouse JH (2002) Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27825 patient evaluations. Radiology 225:165–175CrossRefPubMedGoogle Scholar
  21. 21.
    Crystal P, Strano SD, Shcharynski S, Koretz MJ (2003) Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol 181:177–182PubMedGoogle Scholar
  22. 22.
    Rutter CM, Mandelson MT, Laya MB, Seger DJ, Talpin S (2001) Changes in breast density associated with initiation, discontinuation, and continuing use of hormonal replacement therapy. JAMA 285:171–176CrossRefPubMedGoogle Scholar
  23. 23.
    Corsetti V, Ferrari A, Ghirardi M et al (2006) Role of ultrasonography in detecting mammographically occult breast carcinoma in women with dense breasts. Radiol Med (Torino) 111:440–448CrossRefGoogle Scholar
  24. 24.
    Berg W, Blume JD, Cormack JB et al (2008) Combined screening US and mammography vs. mammography alone in women at elevated risk of breast cancer. JAMA 299:2151–2163CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2009

Authors and Affiliations

  • Fritz K. W. Schaefer
    • 1
    Email author
  • A. Waldmann
    • 2
  • A. Katalinic
    • 2
  • C. Wefelnberg
    • 1
  • M. Heller
    • 1
  • W. Jonat
    • 1
  • I. Schreer
    • 1
  1. 1.MammazentrumUniversity Hospital Schleswig-Holstein Campus KielKielGermany
  2. 2.Krebsregister Schleswig-HolsteinInstitut für Krebsepidemiologie e.V. an der Universität LübeckLübeckGermany

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