title: Non-palpable breast lesions in asymptomatic women: diagnostic value of initial ultrasonography and comparison with mammography.
abstract: OBJECTIVE
  This prospective double-blind study was designed to assess (i) if primary breast screening by ultrasonography is capable of detecting breast cancer independent of tissue density and (ii) if the rate of unnecessary biopsies remains acceptable when diagnostics are based on ultrasonography.
  
  
  METHODS
  Bilateral breast ultrasonography was performed in 448 asymptomatic women as the initial diagnostic method. Sonograms were interpreted using a set of standardized diagnostic criteria. Subsequently, mammograms were obtained. The radiologists reading the mammograms were blinded to the sonographic results.
  
  
  RESULTS
  Overall, 3 non-palpable breast cancers were detected by ultrasound and mammography. All 3 ultrasonographically detected breast cancers were smaller than 1 cm (0.7, 0.7, 0.6 cm). All 3 carcinomas were correctly detected by both methods. For ultrasonography, the false positive rate was 1.1% (n=5) and for mammography 0.6% (n=3). When both methods were combined, the rate of unnecessary open biopsies was 1.6% (n=7). The ratio of benign to malignant lesions was 3.7/1.
  
  
  CONCLUSIONS
  Without prior mammography, primary high-resolution breast ultrasonography is capable of detecting non-palpable breast carcinomas in asymptomatic women at an early stage. The rate of unnecessary open biopsies is low and the ratio of benign to malignant biopsies acceptable.
authors.affiliation: Department of Gynecology and Obstetrics, Ernst-Moritz-Arndt-University, Greifswald, Germany. ralf.ohlinger@uni-greifswald.de
authors.forename: R
authors.initials: R
authors.lastname: Ohlinger
authors.forename: H
authors.initials: H
authors.lastname: Heyer
authors.forename: A
authors.initials: A
authors.lastname: Thomas
authors.forename: S
authors.initials: S
authors.lastname: Paepke
authors.forename: H
authors.initials: H
authors.lastname: Warm
authors.forename: U
authors.initials: U
authors.lastname: Klug
authors.forename: H
authors.initials: H
authors.lastname: Frese
authors.forename: K
authors.initials: K
authors.lastname: Schulz
authors.forename: A
authors.initials: A
authors.lastname: Schimming
authors.forename: G
authors.initials: G
authors.lastname: Schwesinger
authors.forename: G
authors.initials: G
authors.lastname: Köhler
authors.forename: M
authors.initials: M
authors.lastname: Wodny
authors.forename: T
authors.initials: T
authors.lastname: Kohlmann
authors.forename: S
authors.initials: S
authors.lastname: Grunwald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005189:False Positive Reactions; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014463:Ultrasonography