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Breast Imaging |
1 From the Departments of Radiology (H.M.Z., A.E.v.V.), Medical Statistics (J.H.), and Pathology (M.J.v.d.V.), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; and the Department of Radiology, Medical Center Haaglanden-Westeinde, The Hague, the Netherlands (E.G.C.). Received August 11, 1998; revision requested September 25; final revision received February 16, 1999; accepted June 8. Address reprint requests to H.M.Z.
PURPOSE: To determine the value of ultrasonography (US) as an adjunct to mammography for the diagnosis of breast cancer.
MATERIALS AND METHODS: In a 2-year prospective study, 4,811 mammograms were classified according to level of suspicion of malignancy. Targeted US was performed to analyze (a) circumscribed lesions, possibly cysts; (b) palpable lesions visible at mammography; (c) palpable lesions not visible at mammography; and (d) nonpalpable lesions visible at mammography. After US was performed in 1,103 cases (23%), cases were reclassified for level of suspicion.
RESULTS: In 338 cases, breast cancer was diagnosed. The sensitivity of mammography for all 4,811 cases was 83%; the specificity was 97%. After US, the combined sensitivity increased to 91%, with a specificity of 98%. The increase was significant (P < .001). The increase in sensitivity was highest among women younger than 50 years. The positive predictive value for mammography was high (72%), which reflects a high threshold for biopsy; this may have augmented the yield of US.
CONCLUSION: The use of US as an adjunct to mammography resulted in an increase in diagnostic accuracy. Its contribution to the diagnosis of breast cancer in this study was 7.4%.
Index terms: Breast neoplasms, 00.30 • Breast neoplasms, diagnosis, 00.11, 00.1298, 00.30 • Breast neoplasms, US, 00.1298 • Receiver operating characteristic (ROC) curve
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