European Radiology

, Volume 23, Issue 3, pp 684–691 | Cite as

Digital mammography screening: how many breast cancers are additionally detected by bilateral ultrasound examination during assessment?

  • Stefanie Weigel
  • Cornelis Biesheuvel
  • Shoma Berkemeyer
  • Harald Kugel
  • Walter Heindel



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.

Key Points

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.


Breast 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





We thank Ms. Stefanie Michalk for data retrieval.

Our co-author, Dr. Cornelis Biesheuvel, sadly passed away in March this year. We acknowledge not only his contribution to this manuscript but also the unique person, colleague and scientist he was.


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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Stefanie Weigel
    • 1
  • Cornelis Biesheuvel
    • 1
  • Shoma Berkemeyer
    • 1
  • Harald Kugel
    • 1
  • Walter Heindel
    • 1
  1. 1.Department of Clinical Radiology and Reference Center for MammographyUniversity Hospital MuensterMuensterGermany

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