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Epidemiology

Supplemental breast cancer-screening ultrasonography in women with dense breasts: a systematic review and meta-analysis

British Journal of Cancer volume 123, pages 673–688 (2020)Cite this article

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Abstract

Background

Mammography is not effective in detecting breast cancer in dense breasts.

Methods

A search in Medline, Cochrane, EMBASE and Google Scholar databases was conducted from January 1, 1980 to April 10, 2019 to identify women with dense breasts screened by mammography (M) and/or ultrasound (US). Meta-analysis was performed using the random-effect model.

Results

A total of 21 studies were included. The pooled sensitivity values of M alone and M + US in patients were 74% and 96%, while specificity of the two methods were 93% and 87%, respectively. Screening sensitivity was significantly higher in M + US than M alone (risk ratio: M alone vs. M + US = 0.699, P < 0.001), but the slight difference in specificity was statistically significant (risk ratio = 1.060, P = 0.001). Pooled diagnostic performance of follow-up US after initial negative mammography demonstrated a high pooled sensitivity (96%) and specificity (88%). The findings were supported by subgroup analysis stratified by study country, US method and timing of US.

Conclusions

Breast cancer screening by supplemental US among women with dense breasts shows added detection sensitivity compared with M alone. However, US slightly decreased the diagnostic specificity for breast cancer. The cost-effectiveness of supplemental US in detecting malignancy in dense breasts should be considered additionally.

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Fig. 1: Flow diagram of study selection for systematic review and meta-analysis.
Fig. 2: Meta-analysis of cancer diagnostic yield of mammography alone in patients with dense breast.
Fig. 3: Meta-analysis of cancer diagnostic yield of mammography plus ultrasound in patients with dense breast.
Fig. 4: Meta-analysis of differences in cancer diagnostic yield between mammography alone and mammography plus ultrasound in patients with dense breast.
Fig. 5: Meta-analysis of cancer diagnostic yield of follow-up ultrasound in patients with dense breast and negative mammography.
Fig. 6: Quality assessment.

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Acknowledgements

We thank Convergence CT, Taiwan for statistical analysis and English language editing.

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Authors and Affiliations

  1. Division of Radiology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan, ROC

    Wei-Hsin Yuan

  2. School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC

    Wei-Hsin Yuan & Chia-Hung Wu

  3. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    Wei-Hsin Yuan & Chia-Hung Wu

  4. Department of Medical Imaging, Taiwan Adventist Hospital, Taipei, Taiwan, ROC

    Hui-Chen Hsu

  5. Division of Radiology, National Yang-Ming University Hospital, Yilan City, Taiwan, ROC

    Ying-Yuan Chen

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Contributions

W.H.Y. and H.C.H. participated in the conception, design and implementation of the study. H.C.H. and C.H.W. participated in literature research. H.C.H., Y.Y.C. and C.H.W. extracted the data. All of the authors analysed and interpreted the data. W.H.Y. and H.C.H. wrote the paper. Y.Y.C. and C.H.W. revised the paper. W.H.Y. and H.C.H. guaranteed the integrity of the entire study, performed the statistical analysis and definition of intellectual content. All authors reviewed and approved the final paper.

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Correspondence to Wei-Hsin Yuan.

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Yuan, WH., Hsu, HC., Chen, YY. et al. Supplemental breast cancer-screening ultrasonography in women with dense breasts: a systematic review and meta-analysis. Br J Cancer 123, 673–688 (2020). https://doi.org/10.1038/s41416-020-0928-1

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