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

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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.

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References

  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 359:909–919

    Article  PubMed  Google Scholar 

  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 69:349–355

    CAS  PubMed  Google Scholar 

  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 1:829–832

    Article  CAS  PubMed  Google Scholar 

  4. Roberts MM, Alexander FE, Anderson TJ et al (1990) Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet 335:241–246

    Article  CAS  PubMed  Google Scholar 

  5. Bird RE, Wallace TW, Yankaskas BC (1992) Analysis of cancers missed at screening mammography. Radiology 184:613–617

    CAS  PubMed  Google Scholar 

  6. Holland R, Hendriks JH, Mravunac M (1983) Mammographically occult breast cancer: a pathologic and radiologic study. Cancer 52:1810–1819

    Article  CAS  PubMed  Google Scholar 

  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 84:781–785

    Article  CAS  PubMed  Google Scholar 

  8. American College of Radiology (1998) Illustrated Breast Imaging Reporting and Data System (BI-RADS), 3rd edn. American College of Radiology, Reston, VA

    Google Scholar 

  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 99:386–395

    Article  PubMed  Google Scholar 

  10. Boyd NF, Guo M, Martin LJ et al (2007) Mammographic density and the risk and detection of breast cancer. N Engl J Med 356:227–336

    Article  CAS  PubMed  Google Scholar 

  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 91:1404–1408

    Article  CAS  PubMed  Google Scholar 

  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 207:191–199

    CAS  PubMed  Google Scholar 

  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 173:921–927

    CAS  PubMed  Google Scholar 

  14. Kaplan SS (2001) Clinical utility of bilateral whole breast US in the evaluation of women with dense breast tissue. Radiology 221:641–649

    Article  CAS  PubMed  Google Scholar 

  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 96:157–161

    Article  CAS  PubMed  Google Scholar 

  16. Gotzsche PC, Olsen O (2000) Is screening for breast cancer with mammography justifiable? Lancet 355:129–134

    Article  CAS  PubMed  Google Scholar 

  17. Olsen O, Gotzsche PC (2001) Cochrane review on screening for breast cancer with mammography. Lancet 358:1340–1342

    Article  CAS  PubMed  Google Scholar 

  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 91:1724–1731

    Article  CAS  PubMed  Google Scholar 

  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. 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 225:165–175

    Article  PubMed  Google Scholar 

  21. Crystal P, Strano SD, Shcharynski S, Koretz MJ (2003) Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol 181:177–182

    PubMed  Google Scholar 

  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 285:171–176

    Article  CAS  PubMed  Google Scholar 

  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) 111:440–448

    Article  CAS  Google Scholar 

  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 299:2151–2163

    Article  CAS  PubMed  Google Scholar 

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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.

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Authors and Affiliations

  1. Mammazentrum, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Str. 3, Haus 24, 24105, Kiel, Germany

    Fritz K. W. Schaefer, C. Wefelnberg, M. Heller, W. Jonat & I. Schreer

  2. Krebsregister Schleswig-Holstein, Institut für Krebsepidemiologie e.V. an der Universität Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    A. Waldmann & A. Katalinic

Authors
  1. Fritz K. W. Schaefer
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  2. A. Waldmann
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  3. A. Katalinic
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  4. C. Wefelnberg
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  5. M. Heller
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  6. W. Jonat
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  7. I. Schreer
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Corresponding author

Correspondence to Fritz K. W. Schaefer.

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Schaefer, F.K.W., Waldmann, A., Katalinic, A. et al. Influence of additional breast ultrasound on cancer detection in a cohort study for quality assurance in breast diagnosis—analysis of 102,577 diagnostic procedures. Eur Radiol 20, 1085–1092 (2010). https://doi.org/10.1007/s00330-009-1641-x

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  • DOI: https://doi.org/10.1007/s00330-009-1641-x

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