title: Diagnostic utility of combined ultrasonography and mammography in the evaluation of women with mammographically dense breasts.
abstract: OBJECTIVE
  To assess the diagnostic utility and additional cost of combined breast ultrasonography and mammography in the evaluation of asymptomatic women with mammographically dense breasts.
  
  
  METHODS
  Of 5108 asymptomatic women, who underwent mammography, 1754 had dense breasts (BI-RADS 3 or 4) and negative mammographic outcome. They were divided in 4 subgroups according to their age (<40 yrs; 40-49 yrs; 50-59 yrs; >59 yrs). Breast ultrasonography was performed immediately after mammography. Lesions detected at ultrasonography were examined cytologically/histologically. Mammograms from women, who were diagnosed carcinoma at ultrasonography, were reviewed by an external radiologist. Costs per diagnosed carcinoma and per examined woman were calculated on the basis of current regional charges.
  
  
  RESULTS
  Mammographies (5108) were performed, 67 cancers were detected (cancer detection rate 13.1‰): mammography identified 55 carcinomas and ultrasonography performed in women with dense breasts identified 12 cancers (17.9% of all cancers detected, overall cancer detection rate 6.8‰). Ultrasonography identified a benign condition in 1567 out of 1754 women (89.3%) (in 925 absence of focal lesions; 438 simple cysts; 56 ductal ectasia; 148 benign solid lesions); 97 complex cysts, 52 lesions that could not be differentiated as liquid or solid lesions, and 38 solid lesions suspicious for malignancy in the remaining 187 out of 1754 patients (10.7%). Cytology/histology confirmed carcinoma in 12 women (overall biopsy rate 26.2‰, benign biopsy rate 19.4‰). The additional costs were: € 6,123.45 per detected cancer, € 41.89 per examined woman.
  
  
  CONCLUSIONS
  Breast ultrasonography immediately after mammography in women with dense breasts is useful to avoid diagnostic delays and inconvenient medico-legal implications even though this procedure involves increased costs.
authors: Department of Gynaecological Sciences, University of Rome La Sapienza, Rome, Italy.
authors: C
authors: C
authors: De Felice
authors: S
authors: S
authors: Savelli
authors: M
authors: M
authors: Angeletti
authors: L
authors: L
authors: Ballesio
authors: L
authors: L
authors: Manganaro
authors: M L
authors: ML
authors: Meggiorini
authors: L M
authors: LM
authors: Porfiri
keywords: Breast cancer; Breast lesion; Breast ultrasonography
references: J Natl Cancer Inst. 1999 May 19;91(10):833-8
references: 10340902
references: Radiology. 1995 Jul;196(1):14-5
references: 7784557
references: J Ultrasound Med. 2006 Jul;25(7):845-55
references: 16798895
references: AJR Am J Roentgenol. 2004 Feb;182(2):489-91
references: 14736687
references: Br J Cancer. 2004 Jan 26;90(2):393-6
references: 14735182
references: AJR Am J Roentgenol. 1999 Jun;172(6):1621-5
references: 10350302
references: Radiology. 2001 Dec;221(3):641-9
references: 11719658
references: J Natl Cancer Inst. 2000 Jul 5;92(13):1081-7
references: 10880551
references: Radiology. 1998 Nov;209(2):511-8
references: 9807581
references: Radiology. 1999 Dec;213(3):889-94
references: 10580971
references: Radiology. 2002 Oct;225(1):165-75
references: 12355001
references: Clin Imaging. 2001 Nov-Dec;25(6):379-84
references: 11733148
references: Eur J Cancer. 2002 May;38(8):1044-50
references: 12008191
references: Radiology. 2005 Dec;237(3):841-6
references: 16304106
references: AJR Am J Roentgenol. 2003 Jul;181(1):177-82
references: 12818853
references: Eur J Cancer. 1998 Mar;34(4):449-50
references: 9713292
references: Radiology. 1993 Aug;188(2):297-301
references: 8327668
references: Lancet. 1999 Dec 18-25;354(9196):2096-7
references: 10609810
references: Radiology. 1999 Nov;213(2):413-22
references: 10551221
references: AJR Am J Roentgenol. 2001 May;176(5):1261-6
references: 11312192
references: Eur Radiol. 2001;11(12):2425-35
references: 11734935
references: Radiol Clin North Am. 1995 Nov;33(6):1161-70
references: 7480663
references: AJR Am J Roentgenol. 1998 Nov;171(5):1203-6
references: 9798848
references: AJR Am J Roentgenol. 2003 Jun;180(6):1675-9
references: 12760942
references: Radiol Med. 2006 Apr;111(3):440-8
references: 16683089
references: Eur J Radiol. 2007 Feb;61(2):183
references: 17164078
references: J Epidemiol Community Health. 1998 Apr;52(4):267-71
references: 9616416
references: Radiology. 1995 Jul;196(1):123-34
references: 7784555
references: AJR Am J Roentgenol. 2003 Nov;181(5):1426-7; author reply 1427-8
references: 14573453
references: Radiology. 1992 Sep;184(3):613-7
references: 1509041
references: Radiology. 1998 Apr;207(1):191-9
references: 9530316