Comparison of Cancer Yields and Diagnostic Performance of Screening Mammography vs. Supplemental Screening Ultrasound in 4394 Women with Average Risk for Breast Cancer

Abstract

Purpose: The effectiveness of supplemental screening ultrasound (US) was investigated in women ≥ 40 years at average risk for breast cancer regardless of breast parenchymal density. A total of 4394 women at average risk and having previously undergone screening mammography were classified as the mammography group. 

Materials and Methods: Of 4394 women, 2005 underwent screening US after a final assessment of category 1 or 2 on screening mammography, and were categorized as the US group. Category 0, 4, and 5 on mammography and 3, 4, and 5 on US were defined as positive. The cancer yields per 1000 women and diagnostic performance of two groups were compared.

Results: The total cancer and invasive cancer yields for the mammography group were 3.0 (95 % confidence interval 1.6, 5.1) and 2.0 (95 % CI, 0.9, 3.9) per 1000 women, higher than the US values of 2.0 (0.5, 5.1) and 1.0 (0.1, 3.6), not statistically significant. The specificity, accuracy, and positive predictive value (PPV) for mammography were 88.90 % (87.93, 89.81), 88.85 % (87.88, 89.76), and 2.61 % (1.39, 4.41), significantly higher than the US values of 69.07 % (66.99, 71.09), 69.13 % (67.05, 71.15), and 0.64 % (0.18, 1.64). The short-term follow-up rate of mammography was 5.51 % (4.85, 6.22), significantly lower than the rate of 26.58 (24.66, 28.58) for US. 

Conclusion: Supplemental screening US in mammographically negative breasts can find additional carcinomas in women at average risk but is not as effective as screening mammography because of the lower cancer yield, invasive cancer yield, specificity, accuracy, PPV and a high short-term follow-up rate.

Zusammenfassung

Ziel: Die Leistungsfähigkeit des ergänzenden Mammasonografie-Screenings (US) wurde in Frauen ≥ 40 Jahre mit durchschnittlichem Brustkrebsrisiko ohne Berücksichtigung der Dichte des Brustparenchyms ermittelt. Insgesamt 4394 Frauen mit Durchschnittsrisiko und durchgeführtem Mammografie-Screening wurden als Mammografie-Gruppe eingestuft.

Material und Methoden: Bei 2005 der 4394 Frauen wurde nach Endbewertung 1 oder 2 in der Mammografie ein Sonografie-Screening durchgeführt und als US-Gruppe bezeichnet. Die Mammografie-Kategorien 0, 4 und 5 sowie die sonografischen Kategorien 3, 4 und 5 wurden als positiv definiert. Die Krebsausbeute pro 1000 Frauen und der diagnostische Wert beider Gruppen wurden miteinander verglichen.

Ergebnisse: In der Mammografie-Gruppe betrug die Ausbeute an Gesamtkrebserkrankungen 3,0 (95 % Konfidenzinterval: 1,6 – 5,1) und an invasiven Karzinomen 2,0 (95 % CI: 0,9 – 3,9) pro 1000 Frauen und war somit höher als in der US-Gruppe mit 2,0 (0,5 – 5,1) für die Gesamtkrebserkrankungen und 1,0 (0,1 – 3,6) für invasive Karzinome. Dieser Unterschied war statistisch nicht signifikant. Die Mammografie erzielte eine Spezifität von 88,90 % (87,93 – 89,81), eine diagnostische Genauigkeit von 88,85 % (87,88 – 89,76) und einen positiven Vorhersagewert (PPV) von 2,61 % (1,39 – 4,41). Dies war signifikant höher als bei der Sonografie, die eine Spezifität von 69,07 % (66,99 – 71,09), eine Genauigkeit von 69,13 % (67,05 – 71,15) und einen PPV 0,64 % (0,18 – 1,64) erreichte. In der Mammografie betrug die Rate für Kurzzeit-Follow-up 5,51 % (4,85 – 6,22) und war somit signifikant niedriger als beim US mit 26,58 (24,66 – 28,58).

Schlussfolgerung: Bei Frauen mit durchschnittlichem Risiko kann das ergänzende Mammasonografie-Screening bei negativem Befund in der Mammografie zusätzliche Karzinome entdecken. Es ist aber nicht so effektiv wie das Mammografie-Screening wegen der geringeren Ausbeute an Krebsbefunden und invasiven Karzinomen, der niedrigeren Spezifität, Genauigkeit und PPV sowie der höheren Kurzzeit-Follow-up Rate.

Key words

breast - mammography - ultrasound - screening

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