Influence of mammographic density on the diagnostic accuracy of tumor size assessment and association with breast cancer tumor characteristics.
OBJECTIVE
The accuracy of breast cancer staging involves the estimation of the tumor size for the initial decision-making in the treatment. We investigated the accuracy of tumor size estimation and the association between tumor characteristics and breast density (BD).


METHODS
A total of 434 women with a primary diagnosis of breast cancer were included in this prospective study at a specialist breast unit. Estimated tumor characteristics included tumor size, nodal status, estrogen/progesterone receptor status, Ki-67, HER2/neu, vascular invasion. Radiomorphological data included tumor size as assessed by mammography, breast ultrasonography, and clinical examination, and American College of Radiology (ACR) categories for BD.


RESULTS
BD did not have a significant impact on the assessment of tumor size using breast ultrasound (deviation from ACR categories 1-4: 0.55-0.68 cm; P=0.331). The deviation in mammography was significantly different dependent on BD (0.42-0.9 cm; P<0.001). The clinical examination was not affected by BD. Age and tumor size were the only parameters associated with a denser breast in the multivariate analysis. Older women were less likely to have dense breasts (odds ratio 0.157 for women aged >or=70 years), and patients with larger tumors were less likely to have dense breasts (adjusted OR 0.36 for tumors>2 cm).


CONCLUSIONS
Breast ultrasonography is more accurate than mammography for assessing tumor size in breasts with a higher BD. The difference in tumor size assessment needs to be taken into consideration in the design of clinical trials and treatment decisions.
Fasching
Peter A
PA
Department of Gynecology and Obstetrics, Erlangen University Hospital, Universitaetsstrasse 21-23, D-91054 Erlangen, Germany. peter.fasching@gyn.med.uni-erlangen.de <peter.fasching@gyn.med.uni-erlangen.de>
Heusinger
Katharina
K
Loehberg
Christian R
CR
Wenkel
Evelyn
E
Lux
Michael P
MP
Schrauder
Michael
M
Koscheck
Thomas
T
Bautz
Werner
W
Schulz-Wendtland
Rüdiger
R
Beckmann
Matthias W
MW
Bani
Mayada R
MR
D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D010808:Physical Examination; D011446:Prospective Studies; D016217:Ultrasonography, Mammary