Ultrasound and Clinical Characteristics of False-negative Results in Mammography Screening of Dense Breasts

Abstract

Objective: We analyzed the clinical and ultrasound characteristics associated with false-negative mammography results in women with dense breasts.

Materials and methods: The present study included 191 women (mean age, 54.47 ± 11.61 years; range, 31-75 years) who had presented from July 2015 to June 2018 with pathologically confirmed breast cancer. The mammography, conventional ultrasound, and elastography imaging results of these patients were reviewed. Breast density and screening cancer probability from mammography and conventional ultrasound imaging were scored using the Breast Imaging Reporting and Data System. Multivariate logistic regression analysis was performed to identify the factors independently associated with the false-negative results on breast mammographic screening.

Results: Of 191 confirmed breast cancer cases, 55 (28.8%) were assigned to category ≤ 3, and 136 (71.2%) were assigned to category ≥ 4a according to the mammography findings. All the breasts were graded mammographically as dense. A rougher margin (odds ratio [OR], 8.123; 95% confidence interval [CI], 1.731-38.127) was the strongest independent factor associated with negative results, followed by a lower stiffness ratio (OR, 7.773; 95% CI, 2.574-23.473), negative axillary lymph node status (OR, 5.066; 95% CI, 1.028-24.955), and softer lesions (OR, 1.037; 95% CI, 1.001-1.075).

Conclusion: Women with dense breasts, a lower lesion/glandular tissue stiffness ratio, and softer cancer can easily lead to a misdiagnosis using mammography. By giving sufficient attention to the margin, earlier stage cancer with negative lymph node status are more likely to benefit from supplemental ultrasound imaging.

Keywords: Breast cancer; Conventional ultrasonography; Elastography; Margin status; Misdiagnosis mammography results.