Analysis of Rational Use of Ultrasonography and Mammography in Breast Screening

Abstract

Objective To discuss the influence of variable clinical factors on the assessment concordance by mammography (MG) and ultrasonography (US), in order to provide evidences on identifying the more accurate, economical and convenient methodology for breast screening which is more suitable for the primary hospitals. Methods From March 2008 to December 2008, 1400 women joined breast screening by physical exams, mammography and ultrasonography at the Center for Breast Disease of Beijing Haidian Maternal & Child Health Hospital. These subjects were classified into 4 groups based on their physical exam results. ①Isolated nodus group (group A, n=105). ②Tumour and asymmetry incrassation group (group B, n=51). ③Asymmetry incrassation in both galactophore group (group C, n=168). ④No detectable abnormity group (group D, n=936). In order to do further analysis and get conclusions, the images of mammography and ultrasonography were judged by the breast imaging reporting and data system(BI-RADS)standard of American College of Radiology (ACR) and the assessment concordance was analyzed by Kappa test. Further comparing mammography and ultrasonography by χ2 test positive difference in detection rates, and the results analyzed and summarized. Results Comparison of the assessment concordance of mammography, ultrasonography and positive rates: ①Group A was poor(Kappa=0.338, P=0.132)and had no significant difference(χ2=0.702, P=0.402). ②Group B was good(Kappa=0.648, P=0.122)and had no significant difference(χ2=0.050, P=0.822). ③Group C was poor(Kappa=0.177, P=0.077) and had significant difference(χ2=17.769, P=0.000). ④Group D was pretty good(Kappa=0.737, P=0.061)and had no significant difference(χ2=1.873, P=0.171). The overall assessment concordance on the images by two radiologists with BI-RADS guideline was good(Kappa=0.847, P=0.012), and had significant difference(Kappa=0.847, P=0.012). Conclusion ①When isolated nodus was found in physical exam, further assessments together by mammography and ultrasonography should be recommended. ②When tumour and asymmetry incrassation were found in physical exam, further assessment by mammography or ultrasonography could be recommended. ③When incrassation in both galactophore was recognized in physical exam, ultrasonography should be recommended as the first step. ④If no abnormity was detected by physical exam, ultrasonography should be recommended firstly, followed by mammography appropriately based on the patient's age and breast density. Breast ultrasonography and mammography has its own advantages and limitations of inspection in the country's breast cancer screening of large groups of people. We should select the appropriate destination inspection means based on clinical examination results. Key words: breast screening; mammography(MG); ultrasonography(US); breast imaging reporting and data system(BI-RADS)