Comparison of the performance of screening mammography, @entity4270 , and breast US and evaluation of factors that influence them: an analysis of 27,825 XXXX evaluations.

@entity5 @entity1 @entity0 @entity4270
PURPOSE: To (a) determine the performance of screening mammography, ultrasonography (US), and @entity4270 ( @entity4270 ); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of @entity5 detected with each modality; and (d) determine which modality or combination of modalities optimize @entity5 detection. MATERIALS AND METHODS: A total of 11,130 asymptomatic @entity1 underwent 27,825 screening sessions, (mammography and subsequent @entity4270 ). @entity1 with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed @entity5 and negative if findings from biopsy or all screening examinations were negative. RESULTS: In 221 @entity1 , 246 @entity5 were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of @entity4270 , 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%, respectively. Screening breast US increased the number of @entity1 diagnosed with nonpalpable invasive @entity5 by 42% (30 of 71). Mammographic sensitivity declined significantly with increasing breast density (P <.01) (48% for the densest breasts) and in younger @entity1 with dense breasts (P =.02); the effects were independent. Mammography and US together had significantly higher sensitivity (97%) than did mammography and @entity4270 together (74%) (P <.001). @entity5 detected at mammography and/or US were significantly smaller (P =.01) and of lower stage (P =.01) than those detected at @entity4270 . CONCLUSION: Mammographic sensitivity for @entity0 declines significantly with increasing breast density and is independently higher in older @entity1 with dense breasts. Addition of screening US significantly increases detection of small @entity5 and depicts significantly more @entity5 and at smaller size and lower stage than does @entity4270 , which detects independently extremely few @entity5 . Hormonal status has no significant effect on effectiveness of screening independent of breast density.
