Comparison of Mammography in Combination with Breast Ultrasonography Versus Mammography Alone for Breast Cancer Screening in Asymptomatic Women

Aim: To compare the agreement of screening breast mammography plus ultrasound and reviewedmammography alone in asymptomatic women. Materials and
Methods: All breast imaging data were obtained forwomen who presented for routine medical checkup at National Cancer Institute (NCI), Thailand from January2010 to June 2013. A radiologist performed masked interpretations of selected mammographic images retrievedfrom the computer imaging database. Previous mammography, ultrasound reports and clinical data were blindedbefore film re-interpretation. Kappa values were calculated to assess the agreement between BIRADS assessmentcategory and BIRADS classification of density obtained from the mammography with ultrasound in imagingdatabase and reviewed mammography alone.
Results: Regarding BIRADS assessment category, concordancebetween the two interpretations were good. Observed agreement was 96.1%. There was moderate agreement inwhich the Kappa value was 0.58% (95%CI; 0.45, 0.87). The agreement of BI-RADS classification of density wassubstantial, with a Kappa value of 0.60 (95%CI; 0.54, 0.66). Different results were obtained when a subgroupof patients aged ≥60 years were analyzed. In women in this group, observed agreement was 97.6%. There wasalso substantial agreement in which the Kappa value was 0.74% (95%CI; 0.49, 0.98).
Conclusions: The presentstudy revealed that concordance between mammography plus ultrasound and reviewed mammography alonein asymptomatic women is good. However, there is just moderate agreement which can be enhanced if agetargetedbreast imaging is performed. Substantial agreement can be achieved in women aged ≥60. Adjunctivebreast ultrasound is less important in women in this group.