title: Adding 3D automated breast ultrasound to mammography screening in women with heterogeneously and extremely dense breasts: Report from a hospital-based, high-volume, single-center breast cancer screening program.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of the 3D automated breast ultrasound (3D ABUS) when added to full field digital screening mammography (FFDSM), on breast cancer detection and recall rates in asymptomatic women with dense breasts examined in a high-volume breast cancer screening mammography center.
  
  
  METHODS
  1668 asymptomatic women, age 40-74 years, with heterogeneously dense parenchyma (ACR3) or extremely dense breast (ACR4) were included in the study. FFDSM was performed using standard craniocaudal (CC) and mediolateral oblique (MLO) views followed by anteroposterior (AP); lateral (LAT) and medial (MED) acquisitions of 3D ABUS in both breasts. All mammograms were double read by two dedicated breast radiologists. The 3D ABUS was read by the first radiologist immediately after reading the mammograms. The second reader looked at the 3D ABUS only if there was a need for consensus discussion because of unclear or abnormal mammograms or 3D ABUS.
  
  
  RESULTS
  The combined FFDSM and 3D ABUS generated a total of 6.6 cancers per 1000 women screened (95% CI: 3.0, 10.2; p<0.001) compared with 4.2 cancers per 1000 women screened (95% CI) for FFDSM alone. The difference in yield was an additional 2.4 detected cancers per 1000 women screened (95% CI: 0.6, 4.8; p<0.001). The corresponding recall rate per 1000 women screened was 13.8 (95% CI: 9.0, 19.8) for FFDSM alone and 22.8 for combined FFDSM and ABUS (95% CI: 16.2, 30.0), yielding a difference of an additional 9.0 recalls per 1000 women screened (95% CI: 3.0, 15.0; p=0.004).
  
  
  CONCLUSIONS
  The addition of 3D ABUS to FFDSM in women with ACR3 or ACR4 breast density significantly improved invasive breast cancer detection rate with an acceptable recall increase.
authors: At the Time of the Study Department of Breast Imaging, Unilabs Capio S:t Göran Hospital, Stockholm, Sweden. Electronic address: Brigitte.wilczek@capiostgoran.se.
authors: Brigitte
authors: B
authors: Wilczek
authors: Division of Transplantation Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors: Henryk E
authors: HE
authors: Wilczek
authors: ICON Clinical Research, Medical Affairs Statistical Analysis, Barcelona, Spain.
authors: Lawrence
authors: L
authors: Rasouliyan
authors: At the Time of the Study Department of Breast Imaging, Unilabs Capio S:t Göran Hospital, Stockholm, Sweden.
authors: Karin
authors: K
authors: Leifland
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology; D000071060:Breast Density; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D011829:Radiation Dosage; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: 3D ABUS; Breast cancer detection; Breast cancer screening; Breast density; FFDSM; Recall rate