title: Influence of mammographic density on the diagnostic accuracy of tumor size assessment and association with breast cancer tumor characteristics.
abstract: 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.
authors.affiliation: 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>
authors.forename: Peter A
authors.initials: PA
authors.lastname: Fasching
authors.forename: Katharina
authors.initials: K
authors.lastname: Heusinger
authors.forename: Christian R
authors.initials: CR
authors.lastname: Loehberg
authors.forename: Evelyn
authors.initials: E
authors.lastname: Wenkel
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
authors.forename: Michael
authors.initials: M
authors.lastname: Schrauder
authors.forename: Thomas
authors.initials: T
authors.lastname: Koscheck
authors.forename: Werner
authors.initials: W
authors.lastname: Bautz
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schulz-Wendtland
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.forename: Mayada R
authors.initials: MR
authors.lastname: Bani
mesh_terms: 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