The additional value of us to mammography in the diagnosis of breast cancer - A prospective study

Purpose: To assess the additional value of ultrasonography (US) to mammogra phy in the diagnosis of malignant breast tumors. Material and Methods. Prospectively recorded final assessment categories fo r mammography and US were compared for 327 (228 palpable and 99 nonpalpable ) consecutive malignant tumors confirmed at histology. The additional value of US was assessed for a subpopulation of 71 of these 327 malignancies aft er excluding mammographically conclusive malignant findings, ductal carcino mas in situ (DCIS), and invasive carcinomas presenting with suspicious micr ocalcifications, since there is no indication for performing US in these pa tients. Results. A total of 267 (82%) of the 327 malignant tumors were correctly di agnosed on both imaging modalities. Mammography correctly diagnosed 41 canc ers with false-negative US findings as compared with 11 true-positive US di agnoses of malignant tumors with false-negative findings on mammography (Mc Nemar test p < 0.001). US correctly diagnosed ("upgraded") 31 (10%) of the 327 malignant tumors with benign or indeterminate mammographic diagnoses. I n the subpopulation, US upgraded 20 (42%) of 48 palpable and 10 (44%) of 23 nonpalpable malignant tumors. Conclusion: The overall additional value of US to mammography in the diagno sis of breast cancer was rather limited in a population of mixed malignant tumors. Excluding cancers with mammographically conclusive diagnosis and su spicious microcalcifications as well as DCIS from analysis, US correctly up graded more than 40% of palpable and nonpalpable malignant tumors.