Comparison of the diagnostic efficiency for breast cancer in Chinese women using mammography, ultrasound, MRI, and different combinations of these imaging modalities

Abstract

To compare the respective diagnostic efficiency for breast cancer in Chinese women with x-ray mammography (XRM), ultrasound (US), magnetic resonance imaging (MRI; standard dynamic contrasted-enhanced MRI with diffusion-weighted imaging), and different combinations of these imaging modalities, ninety Chinese women patients with clinically suspected breast cancer underwent prospective breast XRM, US, and MRI. The diagnostic performance of each imaging method and different combinations of methods was compared, with the pathological report serving as the gold standard. In this cohort study 54.4% cases with age of 53.2 ± 7.6 years old were categorized as ACR 3 or 4 tissue density. In the diagnosis of breast cancer, sensitivity and diagnostic accuracy [area under the Receiver Operating Characteristic curve (AUC)] were significantly higher for MRI alone than for either XRM alone or US alone (P< 0.05). Of the misdiagnosed cases on XRM, up to 86.7% cancers were located in dense breasts. US and MRI can play important role in screening young Chinese women. The diagnostic sensitivity was significantly higher for combined MRI+US+XRM (98.2%, χ2=25.9, P< 0.001), MRI+US (94.5%, χ2 53.3, P=0.002) and MRI+XRM (92.9%, χ2 = 41,9, P < 0.001). The combination of two or three methods significantly improved the diagnostic sensitivity for breast cancer in Chinese women. When the results based on different imaging modalities or their combinations are inconsistent, further pathological diagnosis is very important for arriving at a correct diagnosis.