Automated breast ultrasound in breast cancer screening of women with dense breasts: Reader study of mammography-negative and mammography-positive cancers

Maryellen L. Giger, Marc F. Inciardi, Alexandra Edwards, John Papaioannou, Karen Drukker, Yulei Jiang, Rachel Brem, Jeremy Bancroft Brown

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The objective of our study was to assess and compare, in a reader study, radiologists' performance in the detection of breast cancer using full-field digital mammography (FFDM) alone and using FFDM with 3D automated breast ultrasound (ABUS). MATERIALS AND METHODS. In this multireader, multicase, sequential-design reader study, 17 Mammography Quality Standards Act-qualified radiologists interpreted a cancerenriched set of FFDM and ABUS examinations. All imaging studies were of asymptomatic women with BI-RADS C or D breast density. Readers first interpreted FFDM alone and subsequently interpreted FFDM combined with ABUS. The analysis included 185 cases: 133 noncancers and 52 biopsy-proven cancers. Of the 52 cancer cases, the screening FFDM images were interpreted as showing BI-RADS 1 or 2 findings in 31 cases and BI-RADS 0 findings in 21 cases. For the cases interpreted as BI-RADS 0, a forced BI-RADS score was also given. Reader performance was compared in terms of AUC under the ROC curve, sensitivity, and specificity. RESULTS. The AUC was 0.72 for FFDM alone and 0.82 for FFDM combined with ABUS, yielding a statistically significant 14% relative improvement in AUC (i.e., change in AUC = 0.10 [95% CI, 0.07-0.14]; p < 0.001). When a cutpoint of BI-RADS 3 was used, the sensitivity across all readers was 57.5% for FFDM alone and 74.1% for FFDM with ABUS, yielding a statistically significant increase in sensitivity (p < 0.001) (relative increase = 29%). Overall specificity was 78.1% for FFDM alone and 76.1% for FFDM with ABUS (p = 0.496). For only the mammography-negative cancers, the average AUC was 0.60 for FFDM alone and 0.75 for FFDM with ABUS, yielding a statistically significant 25% relative improvement in AUC with the addition of ABUS (p < 0.001). CONCLUSION. Combining mammography with ABUS, compared with mammography alone, significantly improved readers' detection of breast cancers in women with dense breast tissue without substantially affecting specificity.

Original languageEnglish (US)
Pages (from-to)1341-1350
Number of pages10
JournalAmerican Journal of Roentgenology
Volume206
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

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Mammography
Early Detection of Cancer
Breast
Breast Neoplasms
Neoplasms
Area Under Curve
ROC Curve

Keywords

  • Breast imaging
  • Screening
  • Ultrasound
  • Whole-breast ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Automated breast ultrasound in breast cancer screening of women with dense breasts : Reader study of mammography-negative and mammography-positive cancers. / Giger, Maryellen L.; Inciardi, Marc F.; Edwards, Alexandra; Papaioannou, John; Drukker, Karen; Jiang, Yulei; Brem, Rachel; Brown, Jeremy Bancroft.

In: American Journal of Roentgenology, Vol. 206, No. 6, 01.06.2016, p. 1341-1350.

Research output: Contribution to journalArticle

Giger, Maryellen L. ; Inciardi, Marc F. ; Edwards, Alexandra ; Papaioannou, John ; Drukker, Karen ; Jiang, Yulei ; Brem, Rachel ; Brown, Jeremy Bancroft. / Automated breast ultrasound in breast cancer screening of women with dense breasts : Reader study of mammography-negative and mammography-positive cancers. In: American Journal of Roentgenology. 2016 ; Vol. 206, No. 6. pp. 1341-1350.
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abstract = "OBJECTIVE. The objective of our study was to assess and compare, in a reader study, radiologists' performance in the detection of breast cancer using full-field digital mammography (FFDM) alone and using FFDM with 3D automated breast ultrasound (ABUS). MATERIALS AND METHODS. In this multireader, multicase, sequential-design reader study, 17 Mammography Quality Standards Act-qualified radiologists interpreted a cancerenriched set of FFDM and ABUS examinations. All imaging studies were of asymptomatic women with BI-RADS C or D breast density. Readers first interpreted FFDM alone and subsequently interpreted FFDM combined with ABUS. The analysis included 185 cases: 133 noncancers and 52 biopsy-proven cancers. Of the 52 cancer cases, the screening FFDM images were interpreted as showing BI-RADS 1 or 2 findings in 31 cases and BI-RADS 0 findings in 21 cases. For the cases interpreted as BI-RADS 0, a forced BI-RADS score was also given. Reader performance was compared in terms of AUC under the ROC curve, sensitivity, and specificity. RESULTS. The AUC was 0.72 for FFDM alone and 0.82 for FFDM combined with ABUS, yielding a statistically significant 14{\%} relative improvement in AUC (i.e., change in AUC = 0.10 [95{\%} CI, 0.07-0.14]; p < 0.001). When a cutpoint of BI-RADS 3 was used, the sensitivity across all readers was 57.5{\%} for FFDM alone and 74.1{\%} for FFDM with ABUS, yielding a statistically significant increase in sensitivity (p < 0.001) (relative increase = 29{\%}). Overall specificity was 78.1{\%} for FFDM alone and 76.1{\%} for FFDM with ABUS (p = 0.496). For only the mammography-negative cancers, the average AUC was 0.60 for FFDM alone and 0.75 for FFDM with ABUS, yielding a statistically significant 25{\%} relative improvement in AUC with the addition of ABUS (p < 0.001). CONCLUSION. Combining mammography with ABUS, compared with mammography alone, significantly improved readers' detection of breast cancers in women with dense breast tissue without substantially affecting specificity.",
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T2 - Reader study of mammography-negative and mammography-positive cancers

AU - Giger, Maryellen L.

AU - Inciardi, Marc F.

AU - Edwards, Alexandra

AU - Papaioannou, John

AU - Drukker, Karen

AU - Jiang, Yulei

AU - Brem, Rachel

AU - Brown, Jeremy Bancroft

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N2 - OBJECTIVE. The objective of our study was to assess and compare, in a reader study, radiologists' performance in the detection of breast cancer using full-field digital mammography (FFDM) alone and using FFDM with 3D automated breast ultrasound (ABUS). MATERIALS AND METHODS. In this multireader, multicase, sequential-design reader study, 17 Mammography Quality Standards Act-qualified radiologists interpreted a cancerenriched set of FFDM and ABUS examinations. All imaging studies were of asymptomatic women with BI-RADS C or D breast density. Readers first interpreted FFDM alone and subsequently interpreted FFDM combined with ABUS. The analysis included 185 cases: 133 noncancers and 52 biopsy-proven cancers. Of the 52 cancer cases, the screening FFDM images were interpreted as showing BI-RADS 1 or 2 findings in 31 cases and BI-RADS 0 findings in 21 cases. For the cases interpreted as BI-RADS 0, a forced BI-RADS score was also given. Reader performance was compared in terms of AUC under the ROC curve, sensitivity, and specificity. RESULTS. The AUC was 0.72 for FFDM alone and 0.82 for FFDM combined with ABUS, yielding a statistically significant 14% relative improvement in AUC (i.e., change in AUC = 0.10 [95% CI, 0.07-0.14]; p < 0.001). When a cutpoint of BI-RADS 3 was used, the sensitivity across all readers was 57.5% for FFDM alone and 74.1% for FFDM with ABUS, yielding a statistically significant increase in sensitivity (p < 0.001) (relative increase = 29%). Overall specificity was 78.1% for FFDM alone and 76.1% for FFDM with ABUS (p = 0.496). For only the mammography-negative cancers, the average AUC was 0.60 for FFDM alone and 0.75 for FFDM with ABUS, yielding a statistically significant 25% relative improvement in AUC with the addition of ABUS (p < 0.001). CONCLUSION. Combining mammography with ABUS, compared with mammography alone, significantly improved readers' detection of breast cancers in women with dense breast tissue without substantially affecting specificity.

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