The influence of breast density on the sensitivity and specificity of ultrasound and mammography in breast cancer diagnosis
Keywords:
Breast cancer, Breast density, Ultrasound, MammographyAbstract
Objective. Th e aim of this study was to analyse the sensitivity and specificity of ultrasound and mammography according to breast densityand determine which of these diagnostic imagings is a more accuratetest for diagnosis of breast cancer. Patients and methods. By meansof a cross-sectional study, ultrasound and mammographic examinationsof 148 women with breast disease symptoms were analysed.All women underwent surgery and all lesions were examined by histologicalexamination which revealed the presence of 63 breast cancers,and 85 benign lesions. Histological examination was used as the “goldstandard”. In relation to breast density, the women were separated intotwo groups, group A: women with “fatty breast” (ACR BI-RADS densitycategories 1 and 2) and group B: women with “dense breast”(categories3 and 4). Ultrasound and mammographic fi ndings were classifi ed onthe BI-RADS categorical scale of 1-5. For statistical data processing, thelogistic regression analysis and the McNemar chi-square test for pairedproportions was used. Th e diff erences on the level of p<0.05 were consideredstatistically signifi cant. Results. In the group of women with breastdensity categories 1 and 2 the diff erence in the sensitivities (p=1) as wellas in the specifi cities (p=0.11) of the two imaging tests was not statisticallysignifi cant. In the group of women with breast density categories3 and 4 the ultrasound sensitivity was signifi cantly higher than themammographic sensitivity (p=0.03) without a statistically signifi cantdiff erence in specifi city (p=0.26). Sensitivity of mammography was(linearly – ex; linearity exists between breast density and the logarithmof odds for a positive result) associated with breast density (likelihoodratio χ2 =15.99, p =0.0001). Th e odds ratio for (the probability of –ex) a positive mammographic result was 0.25 (95% CI, 0.11-0.58). Th esensitivity of ultrasound and specifi city of each test were not (linearly- ex) associated with breast density. Conclusion. Breast density hada signifi cant infl uence on the sensitivity of mammography but noton specifi city. Th is is very important because a certain percentage ofwomen, not only under 40 but also aft er 40, have heterogenous andextremely dense breasts (density categories 3 and 4). In these women,ultrasound is a more accurate imaging test than mammography, whilein the women with fatty breasts (density categories 1 and 2) these imagingtests are almost equally accurate in breast cancer diagnosis.Downloads
References
McPherson K, Steel M, Dixon J. Breast cancerepidemiology, risk factors, and genetic. Brit Med J. 2000;321:624-8.
Devolli-Disha E, Manxhuka-Kerliu S, Ymeri H, Arben K. Comparative accuracy of mammography and ultrasound in women with breast symptoms according to age and breast density. Bosnian journal of basic medical sciences. 2009;9(2):133-6.
Bassett LW, Kimme-Smith C. Breast sonography. AJR. 1991;156:449-55.
Crystal P, Strano SD, Shcharynski S. Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol. 2004;182:259-60.
Kerlikowske K, Grady D, Barclay J, Sickles EA, Ernster V. Eff ect of age, breast density, and family history on the sensitivity of fi rst screening mammography. JAMA. 1996;276:33-8.
Oza AM, Boyd NF. Mammographic parenchymal patterns: a marker of breast cancer risk. Epidemiol Rev. 1993;15:196-208.
Boyd NF, Lockwood GA, Martin LJ, Knight JA, Jong RA, Fishell E, et al. Mammographic densities and risk of breast cancer among subjects with a family history of this disease. J Natl Cancer Inst. 1999;91:1404-8.
American College of Radiology. Illustrated Breast Imaging Reporting and Data System (BI-RADS) 3rd ed. Reston, Va: American College of Radiology, 1998.
Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that infl uence them: an analysis of 27.825 patients evaluations. Radiology. 2002;225:165-75.
Saarenmaa I, Salminen T, Geiger U, Heikkinen P, Hyvärinen S, Isola J, et al. Th e eff ect of age and density of the breast on the sensitivity of breast cancer diagnostic by mammography and ultrasonography. Breast Cancer Res Treat. 2001;67:117-23.
Pinsky RW, Helvie MA. Mammographic breast density: eff ect on imaging and breast cancer risk. J Natl Compr Canc Netw. 2010;8(10):1157-64.
Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356:227-336.
Wong CS, Lim GH, Gao F, Jakes RW, Off man J, Chia KS, Duff y SW. Mammographic density and its interaction with other breast cancer risk factors in an Asian population. Br J Cancer.
;1;104(5):871-4.
Kerlikowske K, Cook AJ, Buist DS, Cummings SR, Vachon C, Vacek P, Miglioretti DL. Breast cancer risk by breast density, menopause, and postmenopausal hormone therapy use.
;20:28(24):3830-7.
Mandelson MT, Oestreicher N, Porter PL, White D, Finder CA, Taplin SH, White E. Breast density as a predictor of mammographic detection: comparison of interval - and screen-detected cancers. J Natl Cancer Inst. 2000;92:1081-108.
Olsen AH, Bihrmann K, Jensen MB, Vejborg I, Lynge E. Breast density and outcome of mammography screening: a cohort study. Br J Cancer. 2009;7;100(7): 1205-8.
Stomper PC, D’Souza DJ, Di Notto PA, Arrendondo MA. Analysis of parenchymal density on mammograms in 1353 women 25-79 years old. AJR Am J Roentgenol. 1996;167:1261-5.
Kim SH, Kim MH, Oh KK. Analysis and Comparison of Breast Density according to on Mammogram between Korean and Western Women. J Korean Radiol Soc. 2000;42(6):1009-14.
Elmore JG, Armstrong K, Lehmann CD, Fletcher SW. Screening for breast cancer. JAMA. 2005;293:1245-56.
Leconte I, Feger C, Galant C, Berlière M, Berg BV, D‘Hoore W, Maldaque B. Mammography and subsequent whole-breast sonographv of nonpalpable breast cancers. Th e importance of radiology breast density. AJR Am J Roentgenol. 2003;180:1675-9.
Kolb TM, Lichv J, Nevvhouse JH. Occult cancer in women with dense breasts Detection with screening US-diagnostic yield and tumor characteristics. Radiology. 1998;207:191-9.
Ciatto S, Rosselli del Turco M, Catarzi S, Morrone D. The contribution of ultrasonography to the differential diagnosis of breast cancer. Neoplasma. 1994;41:341-5.
Ma L, Fishell F, Wright B, Hanna W, Allan S, Boyd NF. Case-control study of factors associated with failure to detect breast cancer by mammography. J Natl Cancer Inst. 1992;84:781-5.
Barlow WE, Lehman CD, Zheng Y, Ballard-Barbash R, Yankaskas BC, Cutter GR et al. Performance of diagnostic mammography for women with signs or symptoms of breast cancer. J Natl Cancer Inst. 2002;7;94(15):1151-9.
