Mammography, sensitivity

Breast cancer has a very high incidence in women. Breast cancer frequently develops into (or is) a systemic disease. The best way to reduce risk due to breast cancer is early tumor detection and surgical removal. The increase in detection rate of breast tumors that are < 1 cm in diameter over the past 10 years can be mostly attributed to improvements in the sensitivity and utilization of mammography. The main utility of CA 15-3 in breast cancer is to monitor patients after mastectomy (14). 

Breast cancer is the most common cancer affecting women in Western societies. In the past decade, the incidence has risen by 25% and the lifetime risk (from 0 to 74 years) for white women developing breast cancer is around 7-8%.77 A combination of physical examination, mammography and fine needle aspiration cytology or needle core biopsy (triple assessment) is currently the most sensitive method for preoperative diagnosis of clinically and radiographically detected breast lesions. 

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For the entire cohort, area under the ROC curve (AUC) using the 7-point scale was 0.78 for digital and 0.74 for film. This ference was not statistically significant Sensitivity, based on the 5-point Bl-RADS scale, was 0.70 for digital mammography and 0.66 for screen-film, also not a statistically significant difference. Figure 9.2a shows the ROC curves for the entire cohort Specificity was the same for each modality at 0.92 positive predictive value for each was 0.05. 

Sensitivity and specificity including interval cancers have been given for some trials. The sensitivity for SFM and FFDM in the paired Co-Ma study with 1 year follow-up was 66 and 48%, respectively (Lewin 2006). The DMIST trial revealed a mean sensitivity of 70% for digital and 66% for analog mammography, and the specificity was 92% for both the modalities (Pisano et al. 2005). From the European studies, sensitivity and specificity has been reported for the two Oslo studies. The sensitivity including interval cancers from the 2-year follow-up in the Oslo I study was 76% for SFM and 59% for FFDM, and the specificity was 89% and 84%, respectively (Skaane et al. 2005, 2009). In the prospective randomized Oslo II study, the sensitivity was 61.5% for SFM and 77.4% for FFDM (p = 0.07), and the specificity was 97.9 and... 

Simple screening mammography has only moderate sensitivity. In the so-called DMIST study, sensitivity was only about 40% in women with very dense breast tissue (Pisano et al. 2005). There are several reasons for the poor sensitivity of mammography when used as a stand- alone technique. First, a focal lesion depicted on a mammogram is often difficult to characterize. Since it is not possible to definitely characterize all inconclusive focal breast lesions by additional diagnostic procedures, the radiologist has to use a set of... 

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