Additional breast ultrasound examinations in clustered calcifications: For improving diagnostic performance

Young Kim Hee, Kyoung Seo Bo, Hee Young Kim, Yie Ann, Ran Cho Kyu, Young Seol Hae, Hoon Cha Sang, Hyun Kim Baek, Soo Son Gil, Won Bae Jung

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Purpose: We wanted to determine whether additional breast ultrasound examinations are needed for patients who have clustered calcifications found by mammography for the detection of breast carcinomas. Methods: We performed targeted ultrasound examinations in 125 consecutive patients who had clustered calcifications found by mammography. Forty-eight pathologically proven patients with 61 breast lesions were included in this study (26 invasive carcinomas, 10 ductal carcinomas in situ and 25 benign diseases). Two breast radiologists evaluated the mammography and the ultrasound findings and they graded the probability of malignancy by consensus as follows: definitely benign 1, probably benign 2, probably malignant 3, and definitely malignant 4. The diagnostic performance values, including the sensitivity, specificity, accuracy, positive predictive value and negative predictive value, for mammography and additional ultrasound were compared using McNemar's test and receiver operating characteristic (ROC) analysis. On the ROC analysis, areas under the ROC curves (AUC) and 95% confidence intervals (CI) were obtained. Results: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for making the diagnosis of breast carcinoma by mammography were 88.9%, 12.0%, 57.4%, 59.3%, and 42.9% and those for additional ultrasound were 94.4%, 64.0%, 82.0%, 79.1%, and 88.9%, respectively. The differences of specificity and accuracy were statistically significant (p=0.0003). On the ROC analysis, ACU were significantly different between mammography (AUC=0.586, 95% CI=0.453-0.711) and ultrasound (AUC=0.823, 95% CI=0.704-0.909) (p=0.003). Clustered calcifications with associated masses or ductal changes on additional breast ultrasound had high frequency of malignancies, 79% or 73%. In addition, 87% of malignant masses were invasive carcinomas and 45% of malignant ductal changes were ductal carcinomas in situ. Conclusion: Additional breast ultrasound examinations for the lesions with clustered calcifications on mammography can improve the diagnostic performance and significantly contribute to the specificity and accuracy of a diagnosis of breast carcinoma. In addition, the ultrasound features may predict the pathologic findings such as benignity or malignancy and invasive carcinoma or ductal carcinoma in situ.

Original languageEnglish
Pages (from-to)142-150
Number of pages9
JournalJournal of Breast Cancer
Issue number3
Publication statusPublished - 2009 Sept
Externally publishedYes

Bibliographical note

Funding Information:
The authors thank the Space Astrophysics Group of the University of California at Berkeley and the crew of the Space Shuttle Columbia for their assistance in the acquisition and reduction of the data presented here. Special thanks are due to Mark Hurwitz for his generous advice and assistance throughout the ORFEUS-SPAS II mission. This research was supported in part by NASA grant NAG5-6695 to the University of Hawaii. T. R. A. acknowledges support by grant NAG5-3226 from NASA to the University of Colorado.


  • Breast neoplasms
  • Calcification
  • Mammography
  • Ultrasonography

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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