Mammogram Plus MRI or Ultrasound Catches More Cancer

Increased detection in women at high risk of breast cancer, but increase also seen in false-positives

TUESDAY, April 3 (HealthDay News) -- The addition of an ultrasound or magnetic resonance imaging (MRI) to annual mammography results in a higher rate of detection of incident breast cancers, according to a study published in the April 4 issue of the Journal of the American Medical Association.

Wendie A. Berg, M.D., Ph.D., of Magee-Womens Hospital in Pittsburgh, and colleagues followed 2,809 women with elevated cancer risk and dense breast tissue. A total of 2,662 women underwent three annual screens with mammography and ultrasound in randomized order. After three rounds of both screenings, women could choose to undergo an MRI.

The researchers found that supplemental incidence screening ultrasound identified 3.7 cancers per 1,000 screens (P < 0.001). For mammography plus ultrasound, the sensitivity was 0.76; specificity, 0.84; and positive predictive value (PPV3), 0.16. The corresponding values for mammography alone were 0.52, 0.91, and 0.38 (P < 0.001 for all comparisons). Breast cancer was diagnosed in 2.6 percent of the 612 MRI participants, with a supplemental yield of 14.7 per 1,000 (P = 0.004). For MRI and mammography plus ultrasound the sensitivity was 1.00; specificity, 0.65; and PPV3, 0.19. For the participants who underwent MRI, the sensitivity of combined mammography and ultrasound was 0.44 (P = 0.004); the specificity was 0.84 (P < 0.001); and the PPV3 was 0.18 (P = 0.98). To detect one cancer, the number of screens needed was 127 for mammography; 234 for supplemental ultrasound; and 68 for MRI after negative mammography and ultrasound results.

"The addition of screening ultrasound or MRI to mammography in women at increased risk of breast cancer resulted in not only a higher cancer detection yield but also an increase in false-positive findings," the authors write.

Several authors disclosed financial ties to the medical device industry.

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