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European Radiology
Published in: European Radiology 3/2010

Open Access 01-03-2010 | Ultrasound

Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts

Authors: Kevin M. Kelly, Judy Dean, W. Scott Comulada, Sung-Jae Lee

Published in: European Radiology | Issue 3/2010

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Abstract

Purpose

Mammography, the standard method of breast cancer screening, misses many cancers, especially in dense-breasted women. We compared the performance and diagnostic yield of mammography alone versus an automated whole breast ultrasound (AWBU) plus mammography in women with dense breasts and/or at elevated risk of breast cancer.

Methods

AWBU screening was tested in 4,419 women having routine mammography (Trial Registration: ClinicalTrials.gov Identifier: NCT00649337). Cancers occurring during the study and subsequent 1-year follow-up were evaluated. Sensitivity, specificity and positive predictive value (PPV) of biopsy recommendation for mammography alone, AWBU and mammography with AWBU were calculated.

Results

Breast cancer detection doubled from 23 to 46 in 6,425 studies using AWBU with mammography, resulting in an increase in diagnostic yield from 3.6 per 1,000 with mammography alone to 7.2 per 1,000 by adding AWBU. PPV for biopsy based on mammography findings was 39.0% and for AWBU 38.4%. The number of detected invasive cancers 10 mm or less in size tripled from 7 to 21 when AWBU findings were added to mammography.

Conclusion

AWBU resulted in significant cancer detection improvement compared with mammography alone. Additional detection and the smaller size of invasive cancers may justify this technology’s expense for women with dense breasts and/or at high risk for breast cancer.
Literature
1.
Colditz GA, Willett WC, Hunter DJ et al (1993) Family history, age, and risk of breast cancer. Prospective data from the Nurses’ Health Study. JAMA 270:338–343
2.
Gail MH, Brinton LA, Byar DP et al (1989) Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81:1879–86CrossRefPubMed
3.
Seidman H, Stellman SD, Mushinski MH (1982) A different perspective on breast cancer risk factors: some implications of the nonattributable risk. CA Cancer J Clin 32:301–313CrossRefPubMed
4.
Shapiro S, Venet W, Strax P, Venet L, Roeser R (1982) Ten to 14-year effect of screening on breast cancer mortality. J Natl Cancer Inst 69:349–355PubMed
5.
Mandelson MT, Oestreicher N, Porter PL et al (2000) Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 92:1081–1087CrossRefPubMed
6.
Dean JC, Ilvento CC (2006) Improved cancer detection using computer-aided detection with diagnostic and screening mammography: Prospective study of 104 cancers. Am J Roentgenol 187:20–28CrossRef
7.
Ho WT, Lam PWT (2003) Clinical performance of computer-assisted detection (CAD) system in detecting carcinoma in breasts of different densities. Clin Rad 58:133–136CrossRef
8.
Pisano ED, Gastonis C, Hendrick E et al (2005) Diagnostic performance of digital versus film mammography for breast cancer screening. N Engl J Med 353:1–11CrossRef
9.
Boyd NF, Guo H, Martin LJ et al (2007) Mammographic density and the risk and detection of breast cancer. N Engl J Med 356:227–36CrossRefPubMed
10.
Bird RE, Wallace TW, Yankaskas BC (1992) Analysis of cancers missed at screening mammography. Radiology 184:613–617PubMed
11.
Birdwell RL, Ikeda DM, O’Shaughnessy KF, Sickles EA (2001) Mammographic characteristics of 115 missed cancers later detected with screening mammography and the potential utility of computer-aided detection. Radiology 219:192–202PubMed
12.
Saslow D, Boetes C, Burke W et al (2007) American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57:75–89CrossRefPubMed
13.
Lin SP, Brown JJ (2007) MR contrast agents: physical and pharmacologic basics. J Magn Reson Imaging. 25:884–899CrossRefPubMed
14.
Griebsh I, Brown J, Boggis C et al (2006) Cost-effectiveness of screening with contrast enhanced magnetic resonance imaging vs X-ray mammography of women at a high familial risk of breast cancer. Br J Cancer 95:801–810CrossRef
15.
Kuhl CK, Schrading S, Bieling HB et al (2007) MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study. Lancet 370:485–492CrossRefPubMed
16.
Schmutzler RK, Rhiem K, Breuer P et al (2006) Outcome of a structured surveillance programme in women with a familial predisposition of breast cancer. Eur J Cancer Prev 15:483–489CrossRefPubMed
17.
Kriege M, Brekelmans CT, Boetes C et al (2004) Efficacy of MRI and mammography for breast cancer screening in women with a familial or genetic predisposition. N Engl J Med 351:427–500CrossRefPubMed
18.
Leach MO, Boggis CR, Dixon AK et al (2005) Screening with magnetic imaging and mammography of a UK population at high familial risk of breast cancer: A prospective mluticentre cohort study (MARIBS). Lancet 365:1769–1778CrossRefPubMed
19.
Liberman L, Feng TL, Dershaw DD, Morris EA, Abramson AF (1998) US-guided core breast biopsy: use and cost-effectiveness. Radiology 208:717–723PubMed
20.
Mendelson EB, Tobin CE (1995) Critical pathways in using breast US. Radiographics 15:935–945PubMed
21.
Parker SH, Jobe WE, Dennis MA et al (1993) US guided automated large-core breast biopsy. Radiology 187:507–511PubMed
22.
Benson SR, Blue J, Judd K, Harman JE (2004) Ultrasound is now better than mammography for the detection of invasive breast cancer. Am J Surg 188:381–385CrossRefPubMed
23.
Berg WA, Gutierrez L, Nessaiver MS et al (2004) Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. Radiology 233:830–849CrossRefPubMed
24.
Crystal P, Strano SD, Shcharynski S, Koretz MJ (2003) Using sonography to screen women with mammographically dense breasts. Am J Roentgenol 181:177–182
25.
Kaplan SS (2001) Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology 221:641–649CrossRefPubMed
26.
Kolb TM, Lichy J, Newhouse JH (1998) Occult cancer in women with dense breasts: detection with screening US—diagnostic yield and tumor characteristics. Radiology 207:191–199PubMed
27.
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 27,825 patient evaluations. Radiology 225:165–175CrossRefPubMed
28.
Leconte I, Feger C, Galant C et al (2003) Mammography and subsequent whole-breast sonography of nonpalpable breast cancers: the importance of radiologic breast density. Am J Roentgenol 180:1675–1679
29.
Moon WK, Noh DY, Im JG (2002) Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology 224:569–576CrossRefPubMed
30.
Buchberger W, DeKoekkoik-Doll P, Springer P, Obrist P, Dunser M (1999) Incidental findings on sonography of the breast: clinical significance and diagnostic workup. Am J Roentgenol 173:921–927
31.
32.
Berg WA, Blume JD, Cormack JB et al (2008) Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 299:2151–2163CrossRefPubMed
33.
Chou YH, Tiu CM, Chiang HR, Chen SP, Chiou HJ, Chiou SY (2006) Ultrasound ACR BI-RADSR Categories Applied in an Automated Breast Ultrasound System: Diagnostic Reliability. Radiological Society of North America scientific assembly and annual meeting program. Oak Brook, Ill: Radiological Society of North America
34.
Destounis S, Young W, Hanson S, Somerville P, Murphy P, Zuley M (2005) Automated Breast Ultrasound: A Pilot Study. Radiological Society of North America scientific assembly and annual meeting program. Oak Brook, Ill: Radiological Society of North America
35.
Wenkel E, Heckmann M, Heinrich M et al (2008) Automated breast ultrasound: lesion detection and BI-RADS classification–a pilot study. Rofo 9:804–808
36.
D’Orsi CJ, Bassett LW, Berg WA et al (2003) Breast Imaging Reporting and Data system, BI-RADS: mammography, 4th edn. American College of Radiology, Reston, VA
37.
Mendelson EB, Baum JK, Berg WA, Merritt CRB, Rubin E (2003) Breast Imaging Reporting and Data System, BI-RADS: Ultrasound, 1st edn. American College of Radiology, Reston, VA
38.
SAS Institute (2004) SAS/STAT user’s guide, version 9.1. SAS Publishing, Cary, NC
39.
40.
Leisenring W, Alonzo T, Pepe MS (2000) Comparisons of predictive values of binary medical diagnostic tests for paired designs. Biometrics 56:345–351CrossRefPubMed
41.
Boyd NF, Byng JW, Jong RA et al (1995) Quantitative Classification of mammographic densities and breast cancer risk: results from the Canadian National Breast Screening Study. J Natl Cancer Inst 87:670–675CrossRefPubMed
42.
Berg W (2009) Tailored supplemental screening for breast cancer: What now and what next? Am J Roentgenol 192:390–399CrossRef
43.
Tilanus-Linthorst MMA, Obdeijn IMM, Bartels KCM, deKonig HJ, Oudkerk M (2000) First experiences in screening women at high risk for breast cancer with MR imaging. Breast Cancer Res Treat 63:53–60CrossRefPubMed
44.
Plevritis SK, Kurian AW, Sigal BM et al (2006) Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. JAMA 295:2374–2384CrossRefPubMed
45.
Weaver DL, Rosenberg RD, Barlow WE et al (2006) Pathologic Findings from the Breast Cancer Surveillance Consortium: Population-Based outcomes in women undergoing biopsy after screening mammography. Cancer 106:732–42CrossRefPubMed
Metadata
Title
Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts
Authors
Kevin M. Kelly
Judy Dean
W. Scott Comulada
Sung-Jae Lee
Publication date
01-03-2010
Publisher
Springer-Verlag
Published in
European Radiology / Issue 3/2010
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-009-1588-y

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