title: Mammographic density is the main correlate of tumors detected on ultrasound but not on mammography.
abstract: Although mammography screening programs do not include ultrasound examinations, some diagnostic units do provide women with both mammography and ultrasonography. This article is concerned with estimating the risk of a breast cancer patient diagnosed in a hospital-based mammography unit having a tumor that is visible on ultrasound but not on mammography. A total of 1,399 women with invasive breast cancer from a hospital-based diagnostic mammography unit were included in this retrospective study. For inclusion, mammograms from the time of the primary diagnosis had to be available for computer-assisted assessment of percentage mammographic density (PMD), as well as Breast Imaging Reporting and Data System (BIRADS) assessment of mammography. In addition, ultrasound findings were available for the complete cohort as part of routine diagnostic procedures, regardless of any patient or imaging characteristics. Logistic regression analyses were conducted to identify predictors of mammography failure, defined as BIRADS assessment 1 or 2. The probability that the visibility of a tumor might be masked at diagnosis was estimated using a regression model with the identified predictors. Tumors were only visible on ultrasound in 107 cases (7.6%). PMD was the strongest predictor for mammography failure, but age, body mass index and previous breast surgery also influenced the risk, independently of the PMD. Risk probabilities ranged from 1% for a defined low-risk group up to 40% for a high-risk group. These findings might help identify women who should be offered ultrasound examinations in addition to mammography.
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.|Biostatistics Unit, Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany.
authors.forename: Lothar
authors.initials: L
authors.lastname: Häberle
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.|Division Hematology/Oncology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Fasching
authors.affiliation: Institute of Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Brehm
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Heusinger
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Sebastian M
authors.initials: SM
authors.lastname: Jud
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Christian R
authors.initials: CR
authors.lastname: Loehberg
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Carolin C
authors.initials: CC
authors.lastname: Hack
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Caroline
authors.initials: C
authors.lastname: Preuss
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
authors.affiliation: Institute of Pathology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Arndt
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Celine M
authors.initials: CM
authors.lastname: Vachon
authors.affiliation: Institute of Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Meier-Meitinger
authors.affiliation: Institute of Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.affiliation: Department of Gynecology and Obstetrics, University Breast Center for Franconia, Erlangen University Hospital, Germany, Friedrich Alexander University of Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.affiliation: Institute of Radiology, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, University Breast Center for Franconia, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Schulz-Wendtland
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D016015:Logistic Models; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: mammographic density; mammography screening; masking; risk prediction