False-negative rate of combined mammography and ultrasound for women with palpable breast masses


Mammography and ultrasound are often used concurrently for patients with palpable breast masses. While mammography has a false-negative rate of approximately 15 %, the addition of breast ultrasound decreases this rate among patients with palpable breast masses. There are no recent outcome data regarding the use of combined reporting of ultrasound and mammography (CRUM) for palpable breast masses. In this study, female patients presenting with a palpable breast mass were retrospectively reviewed in a prospectively entered database at a single institution from June 2010 to July 2013. All cancer cases and false-negative cases using CRUM were identified. Cancer rates, false-negative rates, and negative predictive values were calculated based on CRUM breast imaging-reporting and data system (BI-RADS) categories. One thousand two hundreds and twelve female patients presenting with a palpable breast mass were identified; 77 % of patients had CRUM and 73 % (682/932) were BI-RADS 1–2. Despite negative or benign BI-RADS, 9.5 % of patients with BI-RADS 1–2 (65/682) underwent biopsy, compared to 96 % of patients with a BI-RADS 4–5 designation. Eighty-one patients were found to have cancers; 2 had BI-RADS 1–2 imaging. The false-negative rate of CRUM was 2.4 % (2/81). Since 69 % (428/617) of BI-RADS 1–2 patients without tissue diagnosis had follow-up imaging and/or clinical exam (median: 27 months, range: 2–62 months) and none developed cancers, the cancer rate and negative predictive value of a palpable breast mass of BI-RADS 1–2 were estimated to be 0.3 % (2/682) and 99.7 %, respectively. In the modern era of combined imaging for breast masses, a patient with a low suspicion exam can be reassured with a negative CRUM report.

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  1. 1.

    Dixon JM, Anderson TJ, Lamb J, Nixon SJ, Forrest AP (1984) Fine needle aspiration cytology, in relationships to clinical examination and mammography in the diagnosis of a solid breast mass. Br J Surg 71:593–596

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Hermansen C, Skovgaard Poulsen H, Jensen J et al (1987) Diagnostic reliability of combined physical examination, mammography, and fine-needle puncture (‘‘triple-test’’) in breast tumors. A prospective study. Cancer 60:1866–1871

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Hansell DM, Cooke JC, Parsons CA (1988) The accuracy of mammography alone and in combination with clinical examination and cytology in the detection of breast cancer. Clin Radiol 39:150–153

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Kaufman Z, Shpitz B, Shapiro M, Rona R, Lew S, Dinbar A (1994) Triple approach in the diagnosis of dominant breast masses: combined physical examination, mammography, and fine-needle aspiration. J Surg Oncol 56:254–257

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Vetto J, Pommier R, Schmidt W et al (1995) Use of the ‘‘triple test’’ for palpable breast lesions yields high diagnostic accuracy and cost savings. Am J Surg 169:519–522

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Steinberg JL, Trudeau ME, Ryder DE et al (1996) Combined fine-needle aspiration, physical examination and mammography in the diagnosis of palpable breast masses: the irrelation to outcome for women with primary breast cancer. Can J Surg 39:302–311

    PubMed Central  CAS  PubMed  Google Scholar 

  7. 7.

    Irwig L, Macaskill P, Houssami N (2002) Evidence relevant to the investigation of breast symptoms: the triple test. Breast 11:215–220

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Ariga R, Bloom K, Reddy VB et al (2002) Fine-needle aspiration of clinically suspicious palpable breast masses with histopathologic correlation. Am J Surg 184:410–413

    Article  PubMed  Google Scholar 

  9. 9.

    Wai CJ, Al-Mubarak G, Homer MJ, Goldkamp A, Samenfeld-Specht M, Lee Y, Logvinenko T, Rothschild JG, Graham RA (2013) A modified triple test for palpable breast masses: the value of ultrasound and core needle biopsy. Ann Surg Oncol 20:850–855

    Article  PubMed  Google Scholar 

  10. 10.

    Harvey JA, Mahoney MC, Newell MS et al (2013) ACR appropriateness criteria palpable breast masses. J Am Coll Radiol 10:742–749

    Article  PubMed  Google Scholar 

  11. 11.

    American Cancer Society (2013) Breast cancer facts & figures 2013–2014. American Cancer Society, Inc., Atlanta

    Google Scholar 

  12. 12.

    Wallis MG, Walsh MT, Lee JR (1991) A review of false negative mammography in a symptomatic population. Clin Radiol 44:13–15

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Coveney EC, Geraghty JG, O’Laide R et al (1994) Reasons underlying negative mammography in patients with palpable breast cancer. Clin Radiol 49:123–125

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Murphy IG, Dillon MF, O’Doherty A et al (2007) Analysis of patients with false negative mammography and symptomatic breast carcinoma. J Surg Oncol 96:457–463

    Article  PubMed  Google Scholar 

  15. 15.

    Graf O, Helbich TH, Hopf G et al (2007) Probably benign breast masses at US: is follow-up an acceptable alternative to biopsy. Radiology 244:87–93

    Article  PubMed  Google Scholar 

  16. 16.

    Park YM, Kim EK, Lee JH et al (2008) Palpable breast masses with probably benign morphology at sonography: can biopsy be deferred? Acta Radiol 49:1104–1111

    Article  PubMed  Google Scholar 

  17. 17.

    Thomas DB, Gao DL, Ray RM et al (2002) Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst 94:1445–1457

    Article  PubMed  Google Scholar 

  18. 18.

    Seminglazov VF, Moiseenko VM, Manikhas AG et al (1999) Interim results of a prospective randomized study of self-examination for early detection of breast cancer. Vopr Onkol 45:365–371

    Google Scholar 

  19. 19.

    Moss HA, Britton PD, Flower CD et al (1999) How reliable is modern breast imaging in differentiating benign from malignant breast lesions in the symptomatic population? Clin Radiol 54:676–682

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Moy L, Slanetz PJ, Moore R et al (2002) Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective Review. Radiology 225:176–181

    Article  PubMed  Google Scholar 

  21. 21.

    Beyer T, Moonka R (2003) Normal mammography and ultrasonography in the setting of palpable breast cancer. Am J Surg 185:416–419

    Article  PubMed  Google Scholar 

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Correspondence to Kevin S. Hughes.

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Chan, C.H.F., Coopey, S.B., Freer, P.E. et al. False-negative rate of combined mammography and ultrasound for women with palpable breast masses. Breast Cancer Res Treat 153, 699–702 (2015). https://doi.org/10.1007/s10549-015-3557-2

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  • Breast ultrasound
  • Mammography
  • Palpable breast mass