Academic radiology · 2026
Incremental Cancer Detection and False-Positive Burden of Screening Ultrasound After Negative Digital Breast Tomosynthesis: A 10-Year, 100,000-Examination Retrospective Study.
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Dodelzon Katerina, Shah Shreena, Intorcia Brielle, Marlow Alana, Thomas Charlene, Drotman Michele, Kazam Jacob, Min Robert, Katzen Janine T
Аннотация
RATIONALE AND OBJECTIVES: Screening ultrasound has historically been used as an adjunct to mammography in women with dense breasts. However, most prior evidence predates widespread adoption of digital breast tomosynthesis (DBT), which has substantially improved cancer detection and reduced recall rates.
OBJECTIVE: To evaluate the incremental diagnostic yield and false-positive burden of screening ultrasound in women with negative DBT screening examinations.
METHODS: This retrospective study included all women undergoing concurrent screening mammography with DBT and screening ultrasound at a single academic center from 2014-2024. The study cohort consisted of patients with negative DBT (BI-RADS 1 or 2) and concurrent abnormal screening ultrasound (BI-RADS 0, 3, 4, or 5). Cancer detection rate (CDR), abnormal interpretation rate (AIR), false-positive rate (FPR), and positive predictive values (PPV1 and PPV3) were calculated. Subgroup analyses were performed by age and breast density.
RESULTS: Among 102,993 concurrent screening examinations, 6647 (6.5%) had negative DBT but abnormal ultrasound assessment. This cohort yielded 99 cancers, corresponding to an incremental ultrasound CDR of 1.0 per 1000 screened and PPV1 of 1.5%. The false-positive rate of screening ultrasound was 98.5%. Among 1917 resulting biopsies, 99 were malignant (PPV3 5.2%; false-positive biopsy rate of 94.8%), the majority of which were invasive histologic type (89/99, 89.9%). Cancer detection did not differ significantly by breast density, while false positives increased with age (OR 1.05, p < 0.001).
CONCLUSION: In the DBT era, screening ultrasound after negative mammography provides a modest increase in cancer detection at the cost of high false-positive and biopsy rates. These findings support a shift toward risk-based screening strategies and greater reliance on vascular-based modalities such as MRI or contrast-enhanced mammography (CEM) for supplemental screening in women with dense breasts.
OBJECTIVE: To evaluate the incremental diagnostic yield and false-positive burden of screening ultrasound in women with negative DBT screening examinations.
METHODS: This retrospective study included all women undergoing concurrent screening mammography with DBT and screening ultrasound at a single academic center from 2014-2024. The study cohort consisted of patients with negative DBT (BI-RADS 1 or 2) and concurrent abnormal screening ultrasound (BI-RADS 0, 3, 4, or 5). Cancer detection rate (CDR), abnormal interpretation rate (AIR), false-positive rate (FPR), and positive predictive values (PPV1 and PPV3) were calculated. Subgroup analyses were performed by age and breast density.
RESULTS: Among 102,993 concurrent screening examinations, 6647 (6.5%) had negative DBT but abnormal ultrasound assessment. This cohort yielded 99 cancers, corresponding to an incremental ultrasound CDR of 1.0 per 1000 screened and PPV1 of 1.5%. The false-positive rate of screening ultrasound was 98.5%. Among 1917 resulting biopsies, 99 were malignant (PPV3 5.2%; false-positive biopsy rate of 94.8%), the majority of which were invasive histologic type (89/99, 89.9%). Cancer detection did not differ significantly by breast density, while false positives increased with age (OR 1.05, p < 0.001).
CONCLUSION: In the DBT era, screening ultrasound after negative mammography provides a modest increase in cancer detection at the cost of high false-positive and biopsy rates. These findings support a shift toward risk-based screening strategies and greater reliance on vascular-based modalities such as MRI or contrast-enhanced mammography (CEM) for supplemental screening in women with dense breasts.