Reliability of multimodal evaluation of abnormal screening mammogram results

Abstract OBJECTIVE: Our purpose was to evaluate the effectiveness and reliability of the multimodal evaluation of suspicious or equivocal screening mammogram results by use of ancillary imaging studies and needle biopsies. STUDY DESIGN: This article reports on the experience of the Breast Evaluation Center at Long Beach Memorial Medical Center between 1989 and 1993 where 43,125 screening mammograms were performed. RESULTS: A total of 2866 patients were called back for additional evaluation, which consisted of magnification views and ultrasonography. Since 1990 fine-needle biopsies have been done on selected patients and since 1992 core biopsies have been available. Needle localization excisional biopsies were performed on 344 patients, and 158 cancers were diagnosed. This represents a 46% positive predictive value. Careful follow-up was obtained on the patients seen in 1990 to attempt to determine whether any cancers developed within a year of the time the patients with abnormal screening mammogram results had been evaluated with imaging modalities but no tissue diagnosis made. One cancer may have been missed. The cost savings of this protocol are also examined. CONCLUSION: Multimodal evaluation of patients with suspicious screening mammogram results appears to be a cost effective approach with adequate sensitivity and specificity. (Am J Obstet Gynecol 1996;174:1683-7.)