What type of imaging is most accurate?
In my experience, the problems with sensitivity and specificity in breast imaging is that on the spectrum from definitely benign to definitely malignant, there is a broad area of overlap of these findings in the center that could go either way. This is where the value of combining several imaging modalities becomes clear. Mammo + US roughly = MRI alone in detection of breast cancer.
In day to day practice I consider US to be more specific than mammography. When I see an indeterminate mass on mammo I go to ultrasound to tell me what it is, or at least whether it is cystic of solid.
MRI is very sensitive for enhancing masses but it will show many normal areas of enhancement in addition to the abnormal areas of enhancement. This is where experience in reading breast MRI comes in. If the findings are not large enough to be able to see and evaluate the margin of the mass, I would again rely on US to determine its internal structure.
From the Susan G. Komen web site: Sensitivity and Specificity of Mammo vs. MRI compared to Mammo + MRI results of several studies
From International Journal of Contemporary Medical Research Jan 2017: Click here for article.
Excerpt:"The sensitivity, specificity, Positive predictive value (PPV) and Negative Predictive value (NPV) of mammography in detecting carcinoma breast were 77.8%, 97.7%, 87.5% and 95.6% respectively.
The sensitivity, specificity, PPV and NPV of USG in detecting carcinoma breast were 55.6%, 97.7%, 83.3% and 91.5% respectively.
In our study population 83.0% breast lesion were benign and out of them 77.27% were diagnosed by mammography alone and 72.7% were diagnosed by US alone.
When these modalities were combined, 97.7% of the lesions were diagnosed. The correlation coefficients of mammography alone (0.79), US alone (0.63) and mammography and USG combination (0.88) with FNAC are all positive, and P values are significant of all the modalities.
Conclusion: This study confirms that the mammography and ultrasonography when combined have significantly higher sensitivity and negative predictive value than observed for a single modality in detecting the palpable abnormalities of the breast.”
Edited by Mods to add: Unfortunately DJMammo has stepped away from the Community for personal reasons. Please do not expect an answer from him directly. However, you can still post here in an effort to get help from our other amazing members!