Digital mammography screening: how many breast cancers are additionally detected by bilateral ultrasound examination during assessment?
To assess the positive predictive values of incremental breast cancer detection (PPV1) in relation to the mammographic breast density and of performed biopsies (PPV3) resulting from supplemental bilateral physician-performed whole-breast ultrasound (US) at recall of a population-based digital mammography screening programme.
A total of 2,803 recalled screening participants (50–69 years), who had additional bilateral US with prospectively completed documentation [grading of breast density (ACR 1–4), biopsy recommendation related to US and mammography], were included.
The PPV1 of supplemental cancer detection only by US was 0.21 % (6/2,803) compared to 13.8 % (386/2,803) by mammography. The PPV1 of US-only cancer detection was 0 %, 0.16 % (2/1,220), 0.22 % (3/1,374) and 1.06 % (1/94) for women with breast density of ACR 1, ACR 2, ACR 3 and ACR 4, respectively. The PPV3 of US-only lesion detection was 33.3 % (9/27) compared to 38.0 % (405/1,066) by mammography. The proportion of invasive cancers no larger than 10 mm was 37.5 % (3/8) for US-only detection compared to 38.4 % (113/294) for mammographic detection.
Bilateral ultrasound at recall, in addition to the assessment of screen-detected mammographic abnormalities, resulted in a low PPV of incremental cancer detection only by US, without a disproportional increase of false-positive biopsies.
• Bilateral breast ultrasound was assessed in women recalled following digital mammography screening.
• Overall breast cancer detection rate reached the desired level of European guidelines.
• Additional ultrasound-only cancer detection had a low positive predictive value (0.21 %).
• Ultrasound did detect additional unexpected breast cancers in breasts graded ACR 2–4.
• Bilateral breast ultrasound offers little or only marginal benefit in routine screening.
KeywordsBreast cancer Digital mammography screening Breast ultrasound Early detection of cancer Predictive value of tests
positive predictive value of breast cancer detection
positive predictive value of performed biopsies
- 1.Perry N, Broeders M, de Wolf C et al (2006) European guidelines for quality assurance in breast cancer screening and diagnosis, 4th edn. Office for Official Publications of the European Communities, LuxembourgGoogle Scholar
- 2.World Health Organization and International Agency for Research on Cancer (2002) IARC handbooks of cancer prevention, vol 7: breast cancer screening. IARC, Lyon. Available via http://www.iarc.fr/en/publications/pdfs-online/prev/handbook7/Handbook7_Breast-0.pdf. Accessed 10 Jan 2012
- 3.US Preventive Services Task Force (2009) Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 151:716–726Google Scholar
- 16.Bevers TB, Anderson BO, Bonaccio E et al (2009) NCCN clinical practice guidelines in oncology: breast cancer screening and diagnosis. J Natl Compr Cancer Netw 7:1060–1096Google Scholar
- 17.D’Orsi CJ, Bassett LW, Berg WA et al (2003) Breast Imaging Reporting and Data System: ACR BI-RADS—mammography, 4th edn. American College of Radiology, RestonGoogle Scholar
- 24.Ciatto S, Houssami N, Ambrogetti D, Bonardi R, Collini G, Del Turco MR (2007) Minority report—false negative breast assessment in women recalled for suspicious screening mammography: imaging and pathological features, and associated delay in diagnosis. Breast Cancer Res Treat 105:37–43PubMedCrossRefGoogle Scholar