title: Negligible advantages and excess costs of routine addition of breast ultrasonography to mammography in dense breasts.
abstract: OBJECTIVE
  To assess the role of breast ultrasonography as a complement to negative mammography in radiologically dense breasts.
  
  
  METHODS
  Out of a total series of 49,044 consecutive mammograms reported as negative in asymptomatic women, 25,665 (52.3%) were coded as dense (BI-RADS D3-4) and ultrasonography was recommended. Due to organizational problems, ultrasonography was performed immediately or within 1 month only in 5,227 cases, representing the study series.
  
  
  RESULTS
  Two cancers were detected at immediate ultrasonography (0.03%). The cancer detection rate in women aged 40-49 and 50-69 years was 0.002% and 0.07%, respectively. The benign biopsy rate was 0.5% for core biopsies and 0.02% for surgical biopsies. The cost per ultrasonography-assessed woman was Euro 56.05, whereas the cost per additional mammographically occult but ultrasonography-detected cancer was Euro 146,496.53. The mammograms of the 2 cancer cases underwent blind review by an expert reader and were confirmed as negative.
  
  
  CONCLUSIONS
  Our findings show a low cancer detection rate, substantially lower compared to other clinical studies of ultrasonography in dense breasts, though in accordance with preliminary evidence from an Italian randomized clinical trial within a population-based screening program. The policy of adding ultrasonography to negative mammography in dense breasts seems to have very limited cost-effectiveness, and should not be adopted in routine practice before results of ongoing clinical trials are available.
authors.affiliation: Centro per lo Studio e la Prevenzione Oncologica, Florence, Italy.
authors.forename: Beniamino
authors.initials: B
authors.lastname: Brancato
authors.forename: Rita
authors.initials: R
authors.lastname: Bonardi
authors.forename: Sandra
authors.initials: S
authors.lastname: Catarzi
authors.forename: Chiara
authors.initials: C
authors.lastname: Iacconi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Risso
authors.forename: Renzo
authors.initials: R
authors.lastname: Taschini
authors.forename: Stefano
authors.initials: S
authors.lastname: Ciatto
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000191:economics*; D005260:Female; D006801:Humans; D007558:Italy; D008327:Mammography / Q000191:economics*; D008875:Middle Aged; D016217:Ultrasonography, Mammary / Q000191:economics*