title: Clinical impact of the use of additional ultrasonography in diagnostic breast imaging.
abstract: The degree of adherence with evidence-based guidelines for the use of breast ultrasonography was determined in clinical practice of radiologists in six hospitals. Additional ultrasonography was performed in 2,272 (53%) of all 4,257 patients referred for mammography. High adherence rates (mean: 95%) were observed for guidelines recommending ultrasonography in patients referred for palpable breast masses and abnormal screening and diagnostic mammograms. Lower adherence rates (mean: 81%, Pearson correlation coefficient= -0.57; p=0.001) were found for guidelines advising against additional ultrasonography in patients referred for breast symptoms, a known benign abnormality, a family history or anxiety of breast cancer. The overuse of ultrasonography in 442 patients and underuse in 95 patients led to five additional false-positive results. It was concluded that the guidelines seem workable and feasible in clinical practice and that the current daily routine of diagnostic breast imaging corresponded to a great extent to the guidelines proposed.
authors.affiliation: Department of Radiology, Maastricht University Hospital, P. O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
authors.forename: Luc D B
authors.initials: LD
authors.lastname: Vercauteren
authors.forename: Alphons G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.forename: Dick
authors.initials: D
authors.lastname: Koster
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.forename: Jos M A
authors.initials: JM
authors.lastname: van Engelshoven
authors.forename: Karin
authors.initials: K
authors.lastname: Flobbe
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000592:standards; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000592:standards* / Q000706:statistics & numerical data*