Are Both Ultrasonography and Mammography Necessary for Cancer Investigation of Breast Lumps in Resource-Limited Countries?

Abstract

Objective. To reevaluate the diagnostic value of breast imaging in the diagnosis of breast cancer in areas where health resources are limited. Methods. Patients were women presenting with breast lumps in two university-affiliated tertiary hospitals, Thailand, during 2006 and 2010. Clinical data were abstracted from the breast cancer registration database and patient records. The diagnostic predictive ability of ultrasonography and mammography was obtained from logistic regression analysis and presented with areas under the receiver operating characteristics (AuROCs) curves. Results. Among 3129 breast lumps (3069 women), 854 were diagnosed with breast cancer by certified pathologists. Age and size of lumps alone already predicted cancer correctly in 77.45% (AuROC = 77.45). Additional ultrasonography increased the prediction to 96.22% (P < 0.001). Additional mammography also increased the prediction to 95.99% (P < 0.001). Performing both imaging modalities did not increase the prediction clinically (0.01%–0.24%). More accurate prediction (2.07%–2.21%) may be added by fine needle aspiration cytology (FNAC). Conclusions. Breast imaging is still valuable in settings where health resources are limited. Single breast imaging (only either ultrasonography or mammography) is adequate for cancer diagnosis. It is therefore unnecessary to perform both imaging modalities. Accuracy of the diagnosis may be improved by FNAC, if available.

Ultrasound as the Primary Screening Test for Breast Cancer: Analysis From ACRIN 6666

“…We are not the first to suggest that US could replace mammography in some women, though prior reports are limited to women with symptoms. In 3129 symptomatic women in Thailand, US showed an area under the curve of 0.962, which was better than mammography at 0.954 (P = .015), and adding mammography to US produced statistically insignificant improvement (21). In 1208 focally symptomatic women age 30 to 39 years, Lehman et al (22) found higher sensitivity for US than mammography among the 23 (1.9%) women with cancer, with 22 of 23 (95.6%) cancers seen by US and only 14 of 23 (60.9%) with mammography (P = .0098), albeit with a higher false-positive rate for US.…”

Comparison of ultrasound and mammography for early diagnosis of breast cancer among Chinese women with suspected breast lesions: A prospective trial

“…In the Japan Strategic Anti‐cancer Randomized Trial, 184 breast cancers were detected in 36 859 participants by ultrasound combined with mammography, of whom 41 were positive in mammography only and 67 were positive in ultrasound only, with the diagnosis rate of breast cancer, therefore being higher for ultrasound than that for mammography 14 . A study from Thailand included 3129 symptomatic women and found that the AUC for ultrasound was 0.962, which was superior to that of mammography at 0.954 ( p = 0.015), implying that ultrasound is more accurate than mammography 27 . An international meta‐analysis showed that when looking at data from low‐ and middle‐income countries alone, breast ultrasound did not have lesser sensitivity and specificity than those of mammography 28 .…”

“… 14 A study from Thailand included 3129 symptomatic women and found that the AUC for ultrasound was 0.962, which was superior to that of mammography at 0.954 ( p = 0.015), implying that ultrasound is more accurate than mammography. 27 An international meta‐analysis showed that when looking at data from low‐ and middle‐income countries alone, breast ultrasound did not have lesser sensitivity and specificity than those of mammography. 28 Even in Western countries, ultrasound is no less sensitive and accurate than mammography.…”

The role of the IAC Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy and the ACR Breast Imaging‐Reporting and Data System in the evaluation of breast lesions

“…Each BI‐RADS category has a reported likelihood of cancer and a proposed management recommendation. Studies in the literature state that the use of imaging combined with FNAB increased the rate of prediction of malignancies 6,7 …”