Performance evaluation of breast cancer diagnosis with mammography, ultrasonography and magnetic resonance imaging.

OBJECTIVE Various imaging modalities have been used to diagnose suspicious breast lesions. Purpose of this study is to compare the diagnostic accuracy for breast cancer using mammography, ultrasonography and magnetic resonance imaging (MRI). METHODS Total 107 patients aged from 19 to 62 years are included in this retrospective study. Mammography, ultrasonography and MRI scans were performed for each patient detected with suspected breast tumor within a month. In addition, the tumor diversity (10 types of benign and 5 types of malignant) was confirmed by pathological findings of tumor biopsy. To compare the diagnosis performance of the three imaging modalities, the overall fraction correct (accuracy), positive predict value (PPV), negative predict value (NPV), sensitivity and specificity were calculated. Meanwhile, the receiver operating characteristic (ROC) analysis was also performed. RESULTS The diagnostic accuracy ranged from 78.5% to 86.9% among three imaging modalities. All modalities yielded a PPV lower than 77.8% and a NPV higher than 90.0% in identifying the presence of malignant tumors. MRI presented a diagnostic accuracy of 86.9%, as well as a sensitivity of 95.5% and an area under curve (AUC) of 0.948, which are higher than mammography and ultrasonography. CONCLUSION By using a diverse dataset and comparing the diagnostic accuracy of three imaging modalities commonly used in breast cancer detection and diagnosis, this study also demonstrated that mammography, ultrasonography and MRI had different diagnostic performance in breast tumor identification. Among them, MRI yielded the highest performance even though the unexpected specificity may lead to over-diagnosis, and ultrosonography is slightly better than mammography.

[1]  A Russell Localio,et al.  Multimodality screening of high-risk women: a prospective cohort study. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  Rebecca S Lewis,et al.  Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. , 2004, Radiology.

[3]  J. Elmore,et al.  Diagnostic concordance among pathologists interpreting breast biopsy specimens. , 2015, JAMA.

[4]  Martin P Tornai,et al.  Characterization of X-ray scattering for various phantoms and clinical breast geometries using breast CT on a dedicated hybrid system. , 2017, Journal of X-ray science and technology.

[5]  Quan-Xin Yang,et al.  Significant MRI indicators of malignancy for breast non-mass enhancement. , 2017, Journal of X-ray science and technology.

[6]  K. Kelly,et al.  Breast cancer detection using automated whole breast ultrasound and mammography in radiographically dense breasts , 2009, European Radiology.

[7]  Wei Zhao,et al.  Breast ultrasound image enhancement using fuzzy logic. , 2006, Ultrasound in medicine & biology.

[8]  N Houssami,et al.  A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. , 2007, European journal of cancer.

[9]  Hiroshi Honda,et al.  Enhanced mass on contrast‐enhanced breast MR imaging: Lesion characterization using combination of dynamic contrast‐enhanced and diffusion‐weighted MR images , 2008, Journal of magnetic resonance imaging : JMRI.

[10]  Markus Hahn,et al.  Early detection of breast cancer: benefits and risks of supplemental breast ultrasound in asymptomatic women with mammographically dense breast tissue. A systematic review , 2009, BMC Cancer.

[11]  Tom Fawcett,et al.  An introduction to ROC analysis , 2006, Pattern Recognit. Lett..

[12]  F. Diekmann,et al.  Diagnostic performance of a near-infrared breast imaging system as adjunct to mammography versus X-ray mammography alone , 2012, European Radiology.

[13]  Jennifer D. Brooks,et al.  Background parenchymal enhancement at breast MR imaging and breast cancer risk. , 2011, Radiology.

[14]  D. Plewes,et al.  Systematic Review: Using Magnetic Resonance Imaging to Screen Women at High Risk for Breast Cancer , 2008, Annals of Internal Medicine.

[15]  Hui-Cheng Cheng,et al.  Breast Cancers Detected by Breast MRI Screening and Ultrasound in Asymptomatic Asian Women: 8 Years of Experience in Taiwan , 2012, Oncology.

[16]  Wei Zhang,et al.  Diffuse optical tomography for breast cancer imaging guided by computed tomography: A feasibility study. , 2017, Journal of X-ray science and technology.

[17]  M. J. van de Vijver,et al.  Diagnosis of breast cancer: contribution of US as an adjunct to mammography. , 1999, Radiology.

[18]  M. Shetty,et al.  Magnetic resonance imaging and breast ultrasonography as an adjunct to mammographic screening in high-risk patients. , 2011, Seminars in ultrasound, CT, and MR.

[19]  J. Lortet-Tieulent,et al.  Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. , 2015, JAMA.

[20]  Amy Cantor,et al.  Harms of Breast Cancer Screening: Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation , 2016, Annals of Internal Medicine.

[21]  Min Jung Kim,et al.  Breast ultrasonography in young Asian women: analyses of BI-RADS final assessment category according to symptoms , 2011, Acta radiologica.

[22]  C. Kuhl,et al.  Assessment of BI-RADS category 4 lesions detected with screening mammography and screening US: utility of MR imaging. , 2015, Radiology.

[23]  C. Boetes,et al.  Breast MRI: guidelines from the European Society of Breast Imaging , 2008, European Radiology.