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PubMed1993

Increasing compliance with mammography recommendations: health assessment forms.

BACKGROUND: Inexpensive reminder systems are needed to ensure that primary care physicians consistently provide health maintenance services to their patients. The purpose of this study was to determine the effectiveness of a simple, inexpensive health assessment form in place of the standard chart note to increase physician compliance with mammography recommendations. METHODS: A health assessment form with a reminder for screening mammography was implemented in a family practice in 1987 and was to be used as the official chart record for health maintenance visits. The charts of all women 50 years of age and older with two or more office visits during the years 1985 through 1988 were audited to determine how many mammograms were completed. Results were compared with mammography completion rates at a similar practice that did not use a health assessment form. RESULTS: The study group showed a significant increase in mammography completion after implementation of the form, with compliance increasing from 7.3% to 32.0% (P < .001). The comparison group had an increase in mammogram completion from 12.0% to 17.8% (P < .001). The difference between the changes in rates of mammography in the two practices was statistically significant (P < .001). Among women in the study group who had a scheduled health maintenance visit during the study period the average rate of mammography completion increased from 21.2% to 65.2% (P < .001). CONCLUSIONS: The addition of a health assessment form with a mammography reminder at the health maintenance visit is an effective and inexpensive method to increase compliance with mammography.

Adolescent↗
PubMedDate not supplied

Screening mammography use: the importance of a population perspective.

Mammography has been shown to be effective in decreasing breast cancer mortality. However, not all women receive recommended screening. The purpose of this study was to measure the effect of systemic health care delivery factors and patient demographic factors on the use of mammography among a population of women with insurance coverage for screening mammography. We studied 8,805 women, 50 to 74 years of age, who were members of a health maintenance organization in Michigan during 1992. Data were obtained from computerized patient registration and billing systems. Estimated household income was based on zip code and 1990 U.S. Census information. During the study period, 47% of the entire study population received a mammogram. Among the 4,628 women who did not receive a mammogram, 2,358 (51%) did not have any primary care visits in 1992, or did not have a visit at a time when they were due for mammography. Among women with at least one visit during 1992, 60% received a mammogram. Analysis of this group revealed that Caucasian race, married status, and higher estimated household income were associated with 3%-5% higher mammography rates (in absolute terms); seeing a gynecologist and attending a primary care clinic where mammography was available on site were associated with 10%-11% higher rates; and not having at least one of their primary care visits at a time when due for screening was associated with a 33.5% lower mammography rate. These differences persisted after adjusting for other variables. In this population, factors surrounding health care delivery, such as having an office visit when due for screening, the number of office visits, and having been seen by a gynecologist, had a greater association with mammography use than did demographic factors. A population-based perspective that includes developing outreach strategies for women overdue for screening, who have not visited their health care provider, is as important as further improvements in office-based strategies to increase breast cancer screening.

Breast Neoplasms↗
PubMed1996

The effect of patient and physician reminders on use of screening mammography in a health maintenance organization. Results of a randomized controlled trial.

BACKGROUND: Despite its demonstrated efficacy in reducing breast carcinoma mortality, screening mammography remains underutilized and its promotion in the primary care setting provides an important opportunity for intervention. METHODS: A randomized controlled trial was conducted in two sites of a health maintenance organization (HMO) serving an urban, minority population to evaluate the impact of patient and physician reminders on site visitation and mammography use. Eligible women (n = 2368) were randomly assigned to 1 of 4 intervention combinations (patient and physician reminders individually, together, or neither). The patient reminder letter invited mammography-due women to visit. The physician reminder was a notice placed in the medical record of mammography-due women. Logistic analysis and survival analysis were used to investigate the relationship of intervention status to visitation, time to a visit, and mammography use. RESULTS: The patient reminder intervention had no effect upon rates of study year visitation or mammography at either site. However, among HMO Site 2 enrollees with entitlement insurance, the median time to the next visit was reduced from 12 to 9 weeks in association with assignment to patient reminder intervention. The physician reminder intervention was also effective in increasing the rate of completed mammography at Site 2 among all assignees (36% vs. 22% for those with vs. those without physician reminders) and among assignees who visited (59% vs. 43%). CONCLUSIONS: Patient reminder letters had limited impact on visitation in this setting. Physician reminders are more effective but sites vary in their responsiveness. Further improvement in mammography utilization will require a better understanding of the determinants of patient and physician behavior.

Adult↗
PubMed1997

Why do women's attitudes toward mammography change over time? Implications for physician-patient communication.

The present study examines women's decision making about mammography over a 1-year period, using "decisional balance," a summary of women's positive and negative perceptions about mammography derived from the Transtheoretical Model (TTM). Data were from a survey of women ages 50-74 years who completed both the baseline and 1-year follow-up telephone surveys (n = 1144) for an intervention study to increase the use of mammography screening. A shift toward less favorable perceptions about mammography was related to being a smoker and not having a recent clinical breast examination and Pap test. Change in women's attitudes toward mammography was also related to four dimensions of a woman's information environment. Women who rated the opinions of a physician as somewhat or not important, those who reported that at least one family member or friend discouraged them from having a mammogram, and women who felt they lacked enough people in their social network with whom they could discuss health concerns were less likely to express favorable attitudes about mammography over 1 year. In contrast, women who consistently communicated the value of mammography to others expressed more favorable views of screening over the study period. Interventions designed to promote breast cancer screening must recognize that a woman not only reacts to mammography information provided by significant others in her social network but may proactively reach out to others as an advocate of breast cancer screening, thus reinforcing or changing others' opinions or behavior as well as her own.

Aged↗
PubMed1997

[Programs of early detection of breast cancer and access of mammography in Spain].

BACKGROUND: We studied availability to mammography among Spanish women aged 40 to 70 years, variation in use of the mammography by autonomous community, and the situation and importance of breast cancer screening programs among other factors, in the access to mammography. SUBJECTS AND METHODS: A cross-sectional population survey was conducted in 1994 in a sample of 3,218 women. A questionnaire was used to collect data on the variable access (receipt of at least one mammogram in the last 2 years) as well as different access-related variables. Information on breast cancer screening programs was collected by contacting the responsible institutions. We considered that a program had total coverage if it included all the municipalities in the province and partial if it did not include all municipalities. RESULTS: Twenty-eight percent of women had performed a mammogram. This proportion varied among autonomous communities (AACC) from 11.5 to 73.8%. Breast cancer screening programs existed in 8 AACC. The multivariant analysis revealed an association between access to mammography and the existence of a screening program, especially when the later had total coverage (OR = 7.64; 95% CI = 5.24-11.10). An association was also found between access to mammography and physician-related factors, place of residence and attitudes of women toward mammography. CONCLUSIONS: Less than one third of women aged 40-70 have performed a mammography in the last 2 years, and this proportion varies among AACC. Gynecologist visits and the existence of breast cancer screening programs are fundamental factors in the access to mammography in Spain.

Adult↗
PubMed1997

Breast carcinoma stage in relation to time interval since last mammography: a registry-based study. The Romagna Cancer Registry and Collaborators.

BACKGROUND: In the Romagna Region of Italy, mammography screening for breast carcinoma (BC) was implemented as a routine practice in the regular healthcare system. The Romagna Cancer Registry evaluated the effects of self-selection for mammography on the stage of BC at the time of presentation. METHODS: Of the 851 invasive BC cases registered in 1989-1991, tumor size (T) was documented for 790 (93%) and lymph node status (N) for 681 (80%). Mammography experience was determined by cross-checks with the radiology files in the area. The Mantel-Haenszel chi-square test stratified by age was used to evaluate the difference in the proportion of advanced BC between subsets of patients diagnosed at increasing time intervals since their most recent mammography and those with no previous examination. RESULTS: The incidence of T2+/N1+ (T2 or worse and/or lymph node positive) BC was 71% among patients without previous mammography. No advantage was observed for patients diagnosed within 6-12 months of their last mammography (69%). A marked advantage was associated with intervals varying between 12-23 months (45%; P < 0.001) and between 24-35 months (43%; P < 0.001). For longer intervals, the proportion of T2+/N1+ disease stabilized at 56%. For patients with any interval > 5 years (range, 5-22 years; median, 11 years) the relative stage advantage was significant (P = 0.013). CONCLUSIONS: The stage pattern of patients diagnosed with BC 5-22 years after their last mammography suggests that even if health-aware women who volunteered for screening stop undergoing regular mammography, they present for a relatively prompt diagnosis in the event they develop BC.

Adult↗
PubMed2002

The comparative sensitivity of mammography and ultrasound in women with breast symptoms: an age-specific analysis.

Despite its importance for clinical policy, there is little research on the age at which ultrasound or mammography is the preferred initial diagnostic test in women with breast symptoms. We analysed data from a series of 3799 consecutively presenting cancers. The overall sensitivity was 77.6% for mammography and 80.5% for ultrasound. Sensitivity increased with age in both mammography and ultrasound, though more steeply for mammography. In the 975 women who had both tests, ultrasound had a higher sensitivity than mammography in women younger than 62 years of age, whereas mammography had a higher sensitivity than ultrasound in women older than 62 years. However, if the test results of the 2393 women who had mammography only are compared with the ultrasound results of the 975 women who had both tests, the 'cross-over' age at which the sensitivity of the two tests is equal occurs at the earlier age of 48 years. The presence of a palpable finding increases the sensitivity of ultrasound but does not influence the sensitivity of mammography.

Journal Article↗
PubMed2004

Cassette-based digital mammography.

Over the past several years, digital mammography systems have been installed clinically across North America in small but growing numbers. A photostimulable phosphor-based full-field digital mammography image was evaluated in this investigation. Commonly known as computed radiography (CR), its use closely mimics the screen-film mammography paradigm. System performance using modulation transfer function (MTF) and detective quantum efficiency (DQE) metrics show MTF(2.5 mm(-1)) = 0.5, DQE(2.5 mm(-1)) = 0.3, and MTF(5.0 mm(-1)) = 0.2, DQE(5.0 mm(-1)) = 0.05, for a 26 kVp beam, 0.03 mm molybdenum tube filtration, 4.5 cm tissue attenuation, and 15 mR incident exposure to the detector. Slightly higher DQE values were measured at 32 kVp with 0.025 mm rhodium tube filtration. CR mammography advantages include the ability to use existing mammography machines, where multiple rooms can be converted to "digital" operation, which allows overall cost savings compared to integrated digital mammography systems. Chief disadvantages include the labor-intensive handling of the cassettes prior to and after the imaging exam, lack of a direct interface to the x-ray system for recording technique parameters, and relatively slow processing time. Clinical experience in an IRB-approved research trial has suggested that digital mammography with photostimulable storage phosphors and a dedicated CR reader is a viable alternative to conventional screen-film mammography.

Breast Neoplasms↗
PubMed1996

Knowledge and attitude on screening mammography among low-literate, low-income women.

BACKGROUND: Low-income women utilize screening mammography less frequently, present at more advanced stages of disease, and have higher breast cancer mortality rates then women with higher incomes. The purpose of this study was to examine the relationship of reading ability to the knowledge and attitudes that low-income women have regarding screening mammography. METHODS: A convenience sample of 445 women were interviewed for this study. These women, age 40 years and older, had not had a mammogram in the past year. They were waiting to see a doctor in one of two outpatient clinics at Louisiana State University Medical Center in Shreveport when they were interviewed. A structured questionnaire assessed mammography knowledge and attitudes. Each patient's reading ability was assessed with the Rapid Estimate of Adult Literacy in Medicine (REALM). RESULTS: The women interviewed had a mean age of 56 years. Sixty-nine percent were African American, and 97% lived in households with annual incomes of less than $20,000. On the average, the highest grade completed in school was tenth grade. The average reading level was fourth to sixth grade, with 76% reading below a 9th-grade level. Lower reading ability correlated significantly with less mammography knowledge (P < 0.0001). A lack of accurate information about mammography was prevalent among low-level readers. Thirty-nine percent of women reading at or below a third-grade level did not know why women are given mammograms, compared with 12% of those reading at or above a ninth-grade level. Cost was a great concern in general, but cost concerns did not vary by reading level; 41% of all participants were very concerned about cost. CONCLUSIONS: Limited literacy skills and lack of knowledge about screening mammography may contribute considerably to the underutilization of screening mammograms in low-income women. Screening for reading level may identify a subset of low-income patients who could benefit from specialized education. These results could help guide effective educational interventions and better provider-patient communication about screening mammography for low-literate, low-income women.

Adult↗
PubMed1995

Assessment of response to therapy of primary breast cancer by mammography and physical examination.

BACKGROUND: Accurate assessment of response to treatment is necessary to treat appropriately primary breast cancers that are not surgically removed. This retrospective study was undertaken to compare the effectiveness of physical examination (PE) and mammography to assess response of primary breast cancer to medical therapy in women who were ineligible for initial surgical treatment. METHODS: Thirteen women with 14 breast carcinomas were evaluated for interval changes. Except for 1 patient who had two follow-up studies, the other 12 each had a single follow-up study including PE and mammography; changes therefore were assessed in 15 instances. Response to treatment also was judged by mastectomy results in two instances, changes in metastatic disease by other imaging procedures in five, and changes in primary tumor by computed tomography in two breasts. RESULTS: In 11 of 15 assessments of posttherapy changes, PE and mammography results were similar concerning treatment response. Of four discordant follow-ups, the tumors were found to be stable by PE, whereas they were found to be increasing by mammography in two. In both of these cases, progression of disease outside the breast was identified by other imaging studies, consistent with the mammographic findings. In another case, disease appeared to regress by PE but was unchanged by mammography; disease extent in mastectomy specimens was consistent with that found mammographically and more extensive than that suggested by physical examination. In the fourth case, superficial healing of a fungating tumor was obvious by clinical examination but could not be appreciated by mammography. The detectability of changes was not related to type of treatment. CONCLUSIONS: Physical examination and mammography are both useful in the serial evaluation of breast cancers. Although usually complimentary, disease progression, when it occurs, may be detected by only one of these methods.

Adult↗
PubMed2006

Performance of clinical mammography: a nationwide study from Denmark.

Clinical mammography is the key tool for breast cancer diagnosis, but little is known about the impact of the organisational set-up on the performance. We evaluated whether organisational factors influence the performance of clinical mammography. Clinical mammography data from all clinics in Denmark in the year 2000 were collected and linked to cancer outcome. Use of the National Institute of Radiation Hygiene register for identification of radiology clinics ensured comprehensive nationwide registration. We used the final mammographic assessment at the end of the imaging work-up to determine sensitivity, specificity and accuracy, the latter using a receiver-operating characteristics (ROC) analysis. In 96,534 clinical mammography examinations, sensitivity was 75% and specificity 99%. The presence of at least one high volume-reading radiologist in the clinic increased accuracy (AUC = 0.91 for <1,000 examinations/year and 0.92 for >2,000 examinations/year, p = 0.017). The examination volume per clinic showed no clear effect on performance, as accuracy was significantly higher in clinics with a medium number of examinations (AUC = 0.93 for 2,000-4,000 examinations/year and 0.90 for >6,000 examinations/year, p = 0.003). Accuracy was significantly lower in regions with high annual utilisation rate of clinical mammography, which means the proportion of examined women in a region (AUC = 0.90 for 3.0-5.0% annual utilisation rate and AUC = 0.93 for 2.0-2.5% annual utilisation rate, and p = 0.001), indicating that clinical mammography worked best in patient populations of purely symptomatic women. Our data indicate that to increase the accuracy of clinical mammography at the community level, the presence of an experienced radiologist should be prioritized ahead of raising the clinic size.

Adult↗
PubMed1985

The selected use of ultrasound mammography to improve diagnostic accuracy in carcinoma of the breast.

Our initial experience with diagnostic ultrasound mammography (UM) showed it to be of high diagnostic accuracy and improved specificity when compared with x-ray mammography (XRM) in certain categories of patients. To evaluate this modality further, we reviewed our experience with 600 consecutive patients who underwent ultrasound mammography as part of their initial evaluation for breast disease. Five categories of patients were reviewed: I: age 35 or less--129; II: DY or P-2 pattern on XRM--174; III: negative XRM but symptoms requiring additional evaluation--81; IV: high risk remaining breast in patients previously having mastectomy--48; V: refusal of repeat XRM because of pregnancy, lactation, or fear of radiation exposure--168. Fifty-five solid lesions were diagnosed, including 36 carcinomas. Seventeen of these were not diagnosed on x-ray mammography, giving an improved pick-up of carcinoma in this overall group of 2.83%. Of particular interest was that, of the 27 carcinomas that were found in the group having XRM, 8 or 29.6% were missed on that modality alone. Five of these (62.5%) were patients having a DY pattern. All patients have been followed carefully and re-examined at 3-month intervals, with no evidence of a false negative examination. Overall, we feel diagnostic ultrasound mammography is a valuable adjunct to x-ray mammography and recommend its continued use in selected groups of patients where it has a superior diagnostic accuracy over x-ray mammography alone.

Adolescent↗
PubMedDate not supplied

Community education programs to promote mammography participation in rural New York State.

BACKGROUND: Rural women are less likely to receive screening mammography at recommended intervals. This study evaluated efforts to promote screening mammography among women in rural communities through community education interventions and low-cost mobile mammography van services. METHODS: Two matched sets of communities were identified in an isolated rural region. One area received community education programs in addition to the mammography van for 2 years; the second area received only the van services. The educational programs were designed using diagnostic research methods; they included recruitment of opinion leaders to organize small group breast screening education sessions, an information campaign using direct mail, and primary health care provider education. RESULTS: A household telephone survey conducted 6 months after completion of these programs indicated that mammography utilization and perceived mammography norms were higher among women in the Program area than among women in the Comparison area. Process data were consistent with these findings. Clinical examination and self-examination behaviors were not influenced by the programs. CONCLUSIONS: This study showed that well-focused educational interventions for rural women can increase utilization of screening mammography when access and cost barriers also are reduced.

Adult↗
PubMed1992

Legislative interventions to increase access to screening mammography.

Although numerous studies have established that breast cancer mortality can be significantly reduced through early detection, only a small percentage of women obtain screening mammograms at intervals recommended by the National Cancer Institute, the American Cancer Society, and other major medical organizations. This paper examines the importance of cost as a barrier to routine screening and the state legislative movement to make screening mammography a basic health insurance benefit. Mammography "knowledge, attitudes, and behavior" studies offer conflicting findings on the extent to which cost enters into the decision to have a mammogram. Women seldom report cost as a major reason for postponing or failing to have a mammogram; yet, descriptive studies show a consistently positive relationship between income and mammography use. State mammography reimbursement laws vary greatly with respect to whether screening mammography is a required or optional benefit, payment limits, and eligibility and referral requirements. Although state-specific data on the percentage of women with private health insurance are not available, 1987 National Medical Expenditure Survey estimates for U.S. Census geographic divisions suggest that the New England, East North Central, West North Central, Middle Atlantic, and Mountain states have the highest percentages of women who are privately-insured and, thus, potentially eligible for legislated mammography benefits. Access to screening mammography also is likely to be influenced by the proportion of employer-sponsored health plans that are self-insured and, therefore, exempt from minimum benefit mandates and the extent to which women are aware of the screening coverage.

Adult↗
PubMed1995

Adherence to screening mammography recommendations in a university general medicine clinic.

OBJECTIVE: To determine factors predicting adherence to a health care provider's screening mammography recommendation in a general internal medicine practice. DESIGN: Prospective observational study. SETTING: An urban academic general internal medicine practice. PATIENTS: Three hundred forty-nine asymptomatic women, aged 50 years and older, without prior history of breast cancer, who received a health care provider's recommendation for screening mammography. MEASUREMENT: Independent variables were: patient age, race, insurance type, educational level, and duration of affiliation with the practice; visit type; and health care provider gender and level of training. Dependent variables were acceptance of the recommendation and adherence, defined as undergoing mammography within three months of the recommendation. RESULTS: Overall, 193 (55%) of the women underwent the recommended mammography. Two hundred ninety-eight (85%) initially agreed to the recommendation, and of these, 190 (64%) completed mammography within three months. By univariate analysis, acceptance of the recommendation decreased significantly with increasing age (p < 0.01), and by race (African-Americans 89% vs whites 82%, p = 0.05). Only age remained independently predictive of acceptance in a multiple variable analysis. Among women who accepted the recommendation, adherence varied significantly according to race (white 70% vs nonwhite 59%, p = 0.05), insurance type [Medicare as only insurance 45%, Medicaid 66%, non-health maintenance organization (non-HMO) private 62%, HMO 73%, p = 0.03], and health care provider training (attending physicians 73%, residents 58%, nurse practitioners 47%, p = 0.02). In a logistic regression analysis, insurance type and health care provider training remained independently predictive of adherence. CONCLUSION: Acceptance of screening mammography recommendations decreases with age. Among the women who agreed to the recommendation for screening mammography, insurance type and health care provider level of training best predicted adherence.

Age Factors↗
PubMed2001

Recommendations for a mammography quality assurance program.

In 1989 the ACPSEM published a position paper entitled "A Quality Assurance Programme for Mass Screening in Mammography". This paper described test parameters and performance specifications for the equipment related aspects of a mammography quality assurance program. Advice on test equipment selection was also provided. In the intervening period of time there have been considerable advances in mammography technology creating a need to review a number of the paper's recommendations. There have also been considerable developments in the mammography quality assurance (QA) field, not the least of which includes the American College of Radiology Mammography Accreditation Program (ACR-MAP) and the similarly structured Royal Australian and New Zealand College of Radiologists' Mammography Accreditation Program (RANZCR-MAP). In light of these developments it was decided by the Radiology Interest Group to review the ACPSEM position on those aspects of mammography QA that fall within the medical physicist's area of expertise. This document represents the outcome of those deliberations.

Australia↗
PubMed2005

Is grading of breast fibrosis with mammography feasible?

PURPOSE: To establish a grading system for mammographic fibrosis and correlate it with clinical fibrosis. PATIENTS AND METHODS: Analogous to the LENT/SOMA scale a four-tiered scoring scale of breast fibrosis in mammography (G0 = absent, G1 = barely increased density, G2 = definitely increased density to G3 = very marked density) was established by two observers in a group of 16 patients. Reference mammograms were selected. Independently and blinded to clinical results, three observers scored the fibrosis in mammograms of further 31 patients examined by one radiation oncologist in a cross-sectional follow-up study. Pretreatment parenchyma density was judged according to the American College of Radiology (ACR). Interobserver correlation of mammography scoring as well as correlation of mammography and clinical findings were calculated with Cohen's weighted kappa. All patients had breast-conserving surgery and axillary resection for breast carcinoma T1-2N0-1. The breast was irradiated to a median reference dose of 55 Gy (range 50-60 Gy) with 2 Gy five times weekly or 2.5 Gy four times weekly. Two patients received chemotherapy, 14 patients tamoxifen. Median age was 55 years, median follow-up 8 years (4-15 years). RESULTS: 14 of 31 patients had clinical fibrosis, twelve G1 and two G2. In mammography, mild fibrosis (G1) was seen in 12/12/18 patients (observer 1/2/3) and moderate fibrosis (G2) in 9/10/2 patients. Interobserver correlation for observers 1 and 2 who had developed the score was fair (Cohen's weighted kappa 0.64, 95% confidence interval 0.4-0.88). However, it was weak for observer 3 (0.36 and 0.42, respectively) who relied on reference mammograms only. Independent interobserver correlation of pretreatment breast density was good for all observers (Cohen's weighted kappa 0.73-0.8). The correlation of fibrosis by mammography and palpation was weak (Cohen's weighted kappa 0.32-0.42). CONCLUSION: Grading fibrosis as depicted by mammography is possible, especially if observers prepare by jointly analyzing a training group. It may be useful to study treatment effects, e. g., of fractionation or drugs, because retrospective and repeated analysis is possible. The correlation of mammography with clinical grading should be further evaluated with more objective clinical reference tools.

Breast Neoplasms↗
PubMed2004

Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy.

The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography.

Adult↗