{"corpus_id":18735416,"paper_sha":"e0196af80881aadb6e227e432e3dc5aadb91a393","doi":"10.1001/jama.299.18.2151","arxiv_id":null,"pmid":18477782,"pmcid":"PMC2718688","mag_id":2149988868,"dblp_id":null,"acl_id":null,"title":"Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer.","year":2008,"publication_date":"2008-05-14","venue":"Journal of the American Medical Association (JAMA)","journal":{"name":"JAMA","pages":"\n          2151-63\n        ","volume":"299 18"},"journal_issn":null,"journal_title":null,"publication_types":["Study","JournalArticle"],"pubmed_pub_types":["Comparative Study","Journal Article","Multicenter Study","Randomized Controlled Trial","Research Support, N.I.H., Extramural","Research Support, Non-U.S. Gov't"],"s2_fields_of_study":["Medicine"],"reference_count":58,"citation_count":1361,"influential_citation_count":53,"is_open_access":false,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Adult","mj":false,"ui":"D000328"},{"d":"Aged","mj":false,"ui":"D000368"},{"d":"Aged, 80 and over","mj":false,"ui":"D000369"},{"d":"Biopsy","mj":false,"ui":"D001706"},{"d":"Breast Neoplasms","mj":false,"qs":[{"q":"diagnosis","mj":true,"ui":"Q000175"}],"ui":"D001943"},{"d":"Female","mj":false,"ui":"D005260"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Mammography","mj":true,"ui":"D008327"},{"d":"Mass Screening","mj":false,"qs":[{"q":"methods","mj":false,"ui":"Q000379"}],"ui":"D008403"},{"d":"Middle Aged","mj":false,"ui":"D008875"},{"d":"Predictive Value of Tests","mj":false,"ui":"D011237"},{"d":"Risk Factors","mj":false,"ui":"D012307"},{"d":"Sensitivity and Specificity","mj":false,"ui":"D012680"},{"d":"Ultrasonography, Mammary","mj":true,"ui":"D016217"}],"chemicals":null,"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":null,"s2_open_access_landing_url":null,"s2_open_access_license":null,"s2_open_access_status":null,"pmc_open_access_pdf_url":null,"pmc_open_access_landing_url":null,"pmc_open_access_license":null,"pmc_open_access_status":null,"unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"CONTEXT: Screening ultrasound may depict small, node-negative breast cancers not seen on mammography. OBJECTIVE: To compare the diagnostic yield, defined as the proportion of women with positive screen test results and positive reference standard, and performance of screening with ultrasound plus mammography vs mammography alone in women at elevated risk of breast cancer. DESIGN, SETTING, AND PARTICIPANTS: From April 2004 to February 2006, 2809 women, with at least heterogeneously dense breast tissue in at least 1 quadrant, were recruited from 21 sites to undergo mammographic and physician-performed ultrasonographic examinations in randomized order by a radiologist masked to the other examination results. Reference standard was defined as a combination of pathology and 12-month follow-up and was available for 2637 (96.8%) of the 2725 eligible participants. MAIN OUTCOME MEASURES: Diagnostic yield, sensitivity, specificity, and diagnostic accuracy (assessed by the area under the receiver operating characteristic curve) of combined mammography plus ultrasound vs mammography alone and the positive predictive value of biopsy recommendations for mammography plus ultrasound vs mammography alone. RESULTS: Forty participants (41 breasts) were diagnosed with cancer: 8 suspicious on both ultrasound and mammography, 12 on ultrasound alone, 12 on mammography alone, and 8 participants (9 breasts) on neither. The diagnostic yield for mammography was 7.6 per 1000 women screened (20 of 2637) and increased to 11.8 per 1000 (31 of 2637) for combined mammography plus ultrasound; the supplemental yield was 4.2 per 1000 women screened (95% confidence interval [CI], 1.1-7.2 per 1000; P = .003 that supplemental yield is 0). The diagnostic accuracy for mammography was 0.78 (95% CI, 0.67-0.87) and increased to 0.91 (95% CI, 0.84-0.96) for mammography plus ultrasound (P = .003 that difference is 0). Of 12 supplemental cancers detected by ultrasound alone, 11 (92%) were invasive with a median size of 10 mm (range, 5-40 mm; mean [SE], 12.6 [3.0] mm) and 8 of the 9 lesions (89%) reported had negative nodes. The positive predictive value of biopsy recommendation after full diagnostic workup was 19 of 84 for mammography (22.6%; 95% CI, 14.2%-33%), 21 of 235 for ultrasound (8.9%, 95% CI, 5.6%-13.3%), and 31 of 276 for combined mammography plus ultrasound (11.2%; 95% CI. 7.8%-15.6%). CONCLUSIONS: Adding a single screening ultrasound to mammography will yield an additional 1.1 to 7.2 cancers per 1000 high-risk women, but it will also substantially increase the number of false positives. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00072501.","claims":[{"public_id":"cl_43440cc3a1bca64d04e429ad1a91d898","status":"active","text":"Adding a single screening ultrasound to mammography yields additional cancers in high-risk women but substantially increases false positives.","confidence":0.98,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_43440cc3a1bca64d04e429ad1a91d898"},{"public_id":"cl_68befe42be4110e4e5e0c8b2d0199746","status":"active","text":"Adding screening ultrasound to mammography increases diagnostic yield from 7.6 to 11.8 cancers per 1000 women screened, with a supplemental yield of 4.2 per 1000 women screened.","confidence":0.98,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_68befe42be4110e4e5e0c8b2d0199746"},{"public_id":"cl_6f8654512575c4865f7b9f19c2b01dae","status":"active","text":"Combined mammography plus ultrasound has higher diagnostic accuracy than mammography alone, with area under the receiver operating characteristic curve increasing from 0.78 to 0.91.","confidence":0.97,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_6f8654512575c4865f7b9f19c2b01dae"},{"public_id":"cl_3f6da663030035ca2e4bb9e1fd945ed7","status":"active","text":"Most cancers detected by ultrasound alone were invasive and node-negative, with a median size of 10 mm.","confidence":0.96,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_3f6da663030035ca2e4bb9e1fd945ed7"}],"concepts":[{"public_id":"co_0283833842e097847fa70d11c61ab4d4","status":"active","name":"false positives","description":"Positive screening results that do not correspond to cancer on reference standard assessment.","types":["outcome"],"aliases":[],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_0283833842e097847fa70d11c61ab4d4"},{"public_id":"co_14e4e7a9e7d3f3f405e3360c9c366c5d","status":"active","name":"diagnostic accuracy","description":"A measure of screening performance quantified here by the area under the receiver operating characteristic curve.","types":["outcome measure"],"aliases":["area under the receiver operating characteristic curve","AUC"],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_14e4e7a9e7d3f3f405e3360c9c366c5d"},{"public_id":"co_2995fd30ec1c241255e0ec85354d56ca","status":"active","name":"diagnostic yield","description":"The proportion of screened women with positive screen test results and a positive reference standard.","types":["outcome measure"],"aliases":[],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_2995fd30ec1c241255e0ec85354d56ca"},{"public_id":"co_401978aa60801491187b989d6ac58957","status":"active","name":"high-risk women","description":"Women at elevated risk of breast cancer who were enrolled for screening.","types":["population"],"aliases":["women at elevated risk of breast cancer"],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_401978aa60801491187b989d6ac58957"},{"public_id":"co_4b2960f89271ddb896aec50870c4ae56","status":"active","name":"node-negative lesions","description":"Cancer lesions without evidence of lymph node involvement.","types":["pathologic finding"],"aliases":["negative nodes"],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_4b2960f89271ddb896aec50870c4ae56"},{"public_id":"co_4d3a21f3d1ea868b4cb7ea014ce150db","status":"active","name":"combined mammography plus ultrasound","description":"A combined screening strategy using both mammography and ultrasonography to assess breast cancer detection.","types":["screening strategy"],"aliases":["mammography plus ultrasound"],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_4d3a21f3d1ea868b4cb7ea014ce150db"},{"public_id":"co_59b95946cab6fca25a6ba20e661e346b","status":"active","name":"invasive breast cancers","description":"Breast cancers that have invaded beyond the ductal or lobular epithelium.","types":["disease subtype"],"aliases":["invasive cancers"],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_59b95946cab6fca25a6ba20e661e346b"},{"public_id":"co_81e7a8b248ff53ee31a95ec39390354a","status":"active","name":"mammography","description":"X-ray breast imaging used as the comparator screening test in women at elevated breast cancer risk.","types":["screening test"],"aliases":[],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_81e7a8b248ff53ee31a95ec39390354a"},{"public_id":"co_94cebcb44a0e2fb89459c056472d3882","status":"active","name":"screening ultrasound","description":"Ultrasonographic breast screening performed to detect cancers that may not be seen on mammography.","types":["screening test"],"aliases":["ultrasound screening"],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_94cebcb44a0e2fb89459c056472d3882"},{"public_id":"co_e5ded344a8c90f0a73bd14ce2cec20fb","status":"active","name":"ultrasound alone","description":"Cancer detection attributed only to ultrasonographic screening, with mammography not identifying the lesion.","types":["finding category"],"aliases":[],"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/concepts/co_e5ded344a8c90f0a73bd14ce2cec20fb"}],"external_ids":{"DOI":"10.1001/jama.299.18.2151","ArXiv":null,"PubMed":18477782,"PubMedCentral":"PMC2718688","MAG":2149988868,"DBLP":null,"ACL":null},"open_access":{"is_open_access":false,"pdf_url":null,"landing_url":"https://sah.borca.ai/papers/18735416","source":null,"pdf_url_source":null,"license":null,"reason":"pdf_url_not_indexed"},"reference_availability":{"status":"available","references_indexed":true,"full_text_available":false,"full_text_source":null,"count_basis":"semantic_scholar_metadata","extraction_status":"not_applicable","reason":null},"source":{"provider":"episteme2","base_corpus":"semantic_scholar_dump","freshness_mode":"unknown","basis":["semantic_scholar_metadata","postgres_metadata"],"limits":["paper metadata is based on indexed upstream scholarly datasets","claims and concepts are available only for extracted papers","absence of claims or concepts means no extracted graph data is available in this response"],"status":"available","degraded":false,"degraded_reasons":[],"diagnostics":{"status":"available","degraded":false,"degraded_reasons":[],"metadata_status":"available","graph_status":"available","abstract_status":"available"},"source_flags":5},"paper_id":632222,"paper_uid":"5d1be4c4-178b-445e-98f9-dd906a7ace60","canonical_identity":{"paper_id":632222,"paper_uid":"5d1be4c4-178b-445e-98f9-dd906a7ace60","identity_status":"available","lookup_basis":"semantic_scholar_external_id","compatibility_path":"corpus_id"},"url":"https://sah.borca.ai/papers/18735416"}