The Value Of Ultrasound In Breast Cancer Screening

Objective: To study the application of ultrasound on Chinese female breast cancer screening,based on Chinese female breast cancer screening research projects.It will help to provide evidence for selecting high-risk screening groups,choosing optimal breast cancer screening strategies,and improving breast cancer screening results.Methods: This study consists of two parts.In the first part,we study the role of ultrasound on breast cancer screening among women in China.We collected the information of groups who participate Chinese female breast cancer screening multi-center research projects during the 2008-2010.33234 participants of screening female aged 45 to 65 years were examined by clinical breast examination,ultrasound and mammography examination double-blind methods.Women with suspiciously malignant grouths in the breasts detected by any of these three modalities subsequently under biopsy to determine malignancy.There were 102 patients with breast cancer.To compare different screening methods for accuracy,mixing two technologies in parallel and in series and the three parallel and serial.Evaluation indicators were the sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV).Based on the comparison results,choose the best screening methods and verified in the screening population.In the second part we analyzed the value of screening ultrasound to supplemental mammography among Chinese female.First we explored the value of BUS in mammography negative population.Choosing the right data of ultrasound and mammography based on pathology results,by excluding clinical examination data.31918 women were enrolled in this study,and 99 patients of breast cancer were diagnosed.Through questionnaire survey we collected women's general features,physiological fertility factors and personal history situation.Using Logistic regression analyzed the association between ultrasound results in negative mammography and its influential factors using logistic regression,adjusting for age,menopause status,family income,and education.The detection rate,biopsy rate and characterization of patients with different risk of breast cancer were also analyzed.Taking the analysis of related factors,we discussed the main factors affecting the sensitivity of ultrasound and mechanisms.And then we explored the values of ultrasound in crowd-positive mammography population.According to the BIRADS results,positive mammography results were divided into three groups(BIRADS-0,BIRADS-4,BIRADS-5)and we compared supplementary screening effect and the distribution of the false-positive mammography population.Finally,we estimated the performance of screening ultrasound to supplement mammography among Chinese women with different risk of breast cancer.Results:In the first part,the results of different screening methods accuracy showed that mammography screening alone(sensitivity of 85.86%)was much higher than the Ultrasound alone(62.75%)and clinical examination alone(42.16%),so mammography screening programs were also suitable for Chinese women.Mammography and ultrasound,clinical examination in parallel can significantly enhance the sensitivity,parallelled with the Ultrasound(sensitivity 95.1%)was superior to clinical examination(91.18%).Thus ultrasound and clinical examination are not suitable as first diagnosis tools in breast cancer screening.We found that screening ultrasound to supplemental mammography improved detection rate,while helping to found false-positive mammography population to avoid excessive diagnosis.In the second part,we found that higher BMI(OR=1.290,95%CI,1.007-1.650),dense breast(OR=1.787,95%CI,1.366-2.339),benign breast disease history(OR=1.850,95%CI,1.455-2.353),later age at first birth(OR=1.426,95%CI,1.097-1.854)were positively associated with ultrasound findings.In comparison with other high risk groups,we found that higher BMI women were likely to have more cancers detected(0.55/1000),less biopsy(10.94/1000),more invasion tumors(OR=1.692,95%CI,0.212-13.498)and less negative nodes(OR=0.643,95%CI,0.076-5.417),which did not show statistic significance because of the limited case number.Analysis of related factors shows that absolute breast density(ABD)may be the main influence factors of ultrasonic-positive results.Among the three groups of positive mammography results we found that BIRADS-5 group had little benefit of supplemental ultrasound screening and found BIRADS-4 group and the BIRADS-0 group through ultrasound can help to find the false-positive mammography population,so as to avoid excessive diagnosis.And in BIRADS-4 group,the patients features were likely to have more early stages,smaller size,more DCIS,fewer lymph node metastasis,suggesting relatively low danger level and slower progress.Conclusion: 1,The value of screening Ultrasound was mainly as an adjunct to mammography amone Chinese women.2,In the mammography populations,to maximize the benefit of screening ultrasound as an adjunct to mammography,decisions should be individualized based on BMI of women.3,In the positive mammography populations,screening ultrasound can avoid excessive diagnosis,especially for BIRADS-4 and BIRADS-0 groups.