The use of ultrasonography and digital mammography in women under 40 years with symptomatic breast cancer: a 7-year Irish experience.
BACKGROUND
Breast cancer in women under 40 years of age is rare and typically presents symptomatically. The optimal imaging modality for this patient group is controversial. Most women undergo ultrasonography with/without mammography. Young women typically have dense breasts, which can obscure the features of malignancy on film mammography, however, initial studies have suggested that digital mammography may have a more accurate diagnostic performance in younger women. Ultrasound generally performs well in this age group, although it is poor at detecting carcinoma in situ (DCIS).


OBJECTIVE
To evaluate the comparative diagnostic performance of ultrasonography and digital mammography in the initial diagnostic evaluation of women under 40 years of age with symptomatic breast cancer.


METHODS
Retrospective review of all women under the age of 40 years managed at our symptomatic breast cancer unit from January 2009 to December 2015.


RESULTS
There were 120 patients that met the inclusion criteria for this study. The sensitivity of ultrasonography and digital mammography for breast cancer in this patient group was 95.8 and 87.5 %, respectively. The patients with a false negative mammographic examination were more likely to have dense breasts (p < 0.01). Five patients had a false negative ultrasonographic examination, withal of whom were diagnosed with DCIS detected by mammography.


CONCLUSIONS
This study demonstrates the superior sensitivity of ultrasound for breast cancer in women under the age of 40 years, however, the results show that digital mammography has an important complimentary role in the comprehensive assessment of these patients, particularly in the diagnosis of DCIS.
Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. ciaran.redmond@svuh.ie.
C E
CE
Redmond
Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
G M
GM
Healy
Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
C F
CF
Murphy
Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
A
A
O'Doherty
Department of Breast Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
A
A
Foster
D000328:Adult; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002278:Carcinoma in Situ / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*
Breast cancer; Mammography; Ultrasonography; Young women