title: Incremental cancer detection using breast ultrasonography versus breast magnetic resonance imaging in the evaluation of newly diagnosed breast cancer patients.
abstract: OBJECTIVE
  To compare the incremental cancer detection rate (ICDR) using bilateral whole-breast ultrasonography (BWBUS) vs dynamic contrast-enhanced MRI in patients with primary breast cancer.
  
  
  METHODS
  A retrospective database search in a single institution identified 259 patients with breast cancer diagnosed from January 2011 to August 2014 who underwent mammography, BWBUS and MRI before surgery. Patient characteristics, tumour characteristics and lesions seen on each imaging modality were recorded. The sensitivity, specificity and accuracy for each modality were calculated. ICDRs according to index tumour histology and receptor status were also evaluated. The effect of additional cancer detection on surgical planning was obtained from the medical records.
  
  
  RESULTS
  A total of 266 additional lesions beyond 273 index malignancies were seen on at least 1 modality, of which 121 (45%) lesions were malignant and 145 (55%) lesions were benign. MRI was significantly more sensitive than BWBUS (p = 0.01), while BWBUS was significantly more accurate and specific than MRI (p < 0.0001). Compared with mammography, the ICDRs using BWBUS and MRI were significantly higher for oestrogen receptor-positive and triple-negative cancers, but not for human epidermal growth factor receptor 2-positive cancers. 22 additional malignant lesions in 18 patients were seen on MRI only. Surgical planning remained unchanged in 8 (44%) of those 18 patients.
  
  
  CONCLUSIONS
  MRI was more sensitive than BWBUS, while BWBUS was more accurate and specific than MRI. MRI-detected additional malignant lesions did not change surgical planning in almost half of these patients.
  
  
  CONCLUSIONS
  BWBUS may be a cost-effective and practical tool in breast cancer staging.
authors.affiliation: 1 Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|2 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Hongying
authors.initials: H
authors.lastname: He
authors.affiliation: 1 Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jeri S
authors.initials: JS
authors.lastname: Plaxco
authors.affiliation: 3 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.affiliation: 4 Department of Surgical Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Huo
authors.affiliation: 1 Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Rosalind P
authors.initials: RP
authors.lastname: Candelaria
authors.affiliation: 5 Department of Breast Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Kuerer
authors.affiliation: 1 Breast Imaging Section, Department of Diagnostic Radiology, Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Wei T
authors.initials: WT
authors.lastname: Yang
mesh_terms: D001707:Biopsy, Needle / Q000191:economics / Q000592:standards; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000191:economics / Q000592:standards; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000592:standards; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000191:economics / Q000592:standards