title: Breast Cancer Detection in a Screening Population: Comparison of Digital Mammography, Computer-Aided Detection Applied to Digital Mammography and Breast Ultrasound.
abstract: OBJECTIVE
  We aimed to compare the detection of breast cancer using full-field digital mammography (FFDM), FFDM with computer-aided detection (FFDM+CAD), ultrasound (US), and FFDM+CAD plus US (FFDM+CAD+US), and to investigate the factors affecting cancer detection.
  
  
  METHODS
  In this retrospective study conducted from 2008 to 2012, 48,251 women underwent FFDM and US for cancer screening. One hundred seventy-one breast cancers were detected: 115 invasive cancers and 56 carcinomasin situ. Two radiologists evaluated the imaging findings of FFDM, FFDM+CAD, and US, based on the Breast Imaging Reporting and Data System lexicon of the American College of Radiology by consensus. We reviewed the clinical and the pathological data to investigate factors affecting cancer detection. We statistically used generalized estimation equations with a logit link to compare the cancer detectability of different imaging modalities. To compare the various factors affecting detection versus nondetection, we used Wilcoxon rank sum, chi-square, or Fisher exact test.
  
  
  RESULTS
  The detectability of breast cancer by US (96.5%) or FFDM+CAD+US (100%) was superior to that of FFDM (87.1%) (p=0.019 orp<0.001, respectively) or FFDM+ CAD (88.3%) (p=0.050 orp<0.001, respectively). However, cancer detectability was not significantly different between FFDM versus FFDM+CAD (p=1.000) and US alone versus FFDM+CAD+US (p=0.126). The tumor size influenced cancer detectability by all imaging modalities (p<0.050). In FFDM and FFDM+CAD, the nondetecting group consisted of younger patients and patients with a denser breast composition (p<0.050). In breast US, carcinomain situwas more frequent in the nondetecting group (p=0.014).
  
  
  CONCLUSIONS
  For breast cancer screening, breast US alone is satisfactory for all age groups, although FFDM+ CAD+US is the perfect screening method. Patient age, breast composition, and pathological tumor size and type may influence cancer detection during screening.
authors.affiliation: Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Kyu Ran
authors.initials: KR
authors.lastname: Cho
authors.affiliation: Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Bo Kyoung
authors.initials: BK
authors.lastname: Seo
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Ok Hee
authors.initials: OH
authors.lastname: Woo
authors.affiliation: Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Song
authors.affiliation: Department of Mathematics, School of Natural Sciences, Hanyang University, Seoul, Korea.
authors.forename: Jungsoon
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Whang
authors.affiliation: Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Park
authors.affiliation: Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Ah Young
authors.initials: AY
authors.lastname: Park
authors.affiliation: Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyeseon
authors.initials: H
authors.lastname: Shin
authors.affiliation: Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Hwan Hoon
authors.initials: HH
authors.lastname: Chung
keywords: Breast neoplasms; Computer-assisted diagnosis; Early detection of cancer; Mammary ultrasonography; Mammography