title: Use of ultrasonography as an alternative modality for first-line examination in detecting breast cancer in selected patients.
abstract: BACKGROUND
  Detecting lesions in dense breast tissue can be difficult when using mammography. If a patient can be identified as having an increased likelihood of having dense breast tissue based on background factors, ultrasonography can be selected as an alternative method to detect lesions efficiently. We focused on age and reproductive history as factors that determine whether mammography or ultrasonography should be used first.
  
  
  METHODS
  We retrospectively examined 193 breasts in 192 patients (1 case of bilateral breast cancer) who had undergone surgery and received a histopathologic diagnosis of breast cancer. Patients were divided into the 2 following groups based on age: 40-49 years and > or = 50 years. These groups were then subdivided based on reproductive history as follows: no history of pregnancy, < 3 parturitions (excluding no history of pregnancy), and > or = 3 parturitions. Sensitivities were then compared among the 6 groups.
  
  
  RESULTS
  Significant differences in sensitivities were found between mammography and ultrasonography in 3 groups: patients aged 40-49 years with no history of pregnancy; patients aged 40-49 years with a history of < 3 parturitions; and patients aged > or = 50 years with no history of pregnancy. Limiting the results to these groups, sensitivities were 51.5% (34 of 66 cases) with mammography and 81.8% (54 of 66 cases) with ultrasonography.
  
  
  CONCLUSIONS
  We suggest that ultrasonography be used as a first-line examination in detecting breast cancer in such patients; however, this must be confirmed in a future upscale study using larger numbers of subdivided groups.
authors.affiliation: Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan. ohta.kent@nifty.com
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ohta
authors.forename: Kyoko
authors.initials: K
authors.lastname: Okamoto
authors.forename: Yoshihide
authors.initials: Y
authors.lastname: Kanemaki
authors.forename: Fumio
authors.initials: F
authors.lastname: Tsujimoto
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Nakajima
authors.forename: Mamoru
authors.initials: M
authors.lastname: Fukuda
authors.forename: Machi
authors.initials: M
authors.lastname: Suka
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D018579:Patient Selection; D017584:Reproductive History; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography