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The aim of this study was to assess the diagnostic performance of breast imaging in the diagnosis of breast cancer in a non-screening population. In a consecutive set of patients referred for mammography in one year, the results of palpation and radiological breast imaging were scored on a 5-point grading scale and linked to pathology as gold standard after a follow up period of one year. The diagnostic performance was studied by logistic regression analysis and ROC-curves. There were 1,944 breast examinations in 1,890 patients and 3,816 breasts. Pathology results reported 118 malignancies in 115 women. With a cut-off point between benign and uncertain benign a sensitivity of 89% and a specificity of 98% was found for radiological imaging. ROC-curves showed a significant increase in diagnostic performance when radiology was added to results of palpation and age (p ‫؍‬ 0.007). Radiological imaging tests have a large diagnostic value in the detection of breast cancer in addition to palpation and age. A sensitivity close to 100% could be reached. © 2001 Wiley-Liss, Inc. Key words: breast cancer; imaging; mammography; US; ROCBreast cancer is one of the leading causes of death among women in Western countries. The overall risk for the development of breast cancer over a lifetime is estimated to be 12.5% among American women 1,2 and about 10% among women in The Netherlands. 3 The diagnostic triad for evaluation of breast symptoms, the so-called "triple assessment system," involves clinical examination, radiological imaging and fine needle aspiration (FNA) cytology. If all investigations are carried out together a sensitivity of more than 99% can be obtained. 4,5 The value of mammography in screening for breast cancer is well studied, but the diagnostic value of non-screening breast imaging, using a combination of mammography and ultrasonography when indicated, is not well established. Many studies discussing the value of non-screening breast imaging describe populations diagnosed with breast cancer. 5-9 Very few studies describe breast imaging in a clinical population, 10,11 and these studies did not examine the role of palpation and age in the diagnostic process.The aim of this prospective study was to assess the diagnostic performance of breast imaging in the diagnosis of breast cancer among a non-screening population. MATERIAL AND METHODSAll consecutive patients referred for mammography to the Radiology Department of the University Hospital Maastricht in 1994 were included in the study. Investigations were performed in fixed order. Palpation was followed by standard craniocaudal and mediolateral oblique mammograms. When indicated according to the opinion of the radiologist, patients subsequently underwent ultrasonography. For the purpose of this study, the combination of mammography and ultrasonography will be called "radiological breast imaging."Imaging examinations obtained as follow-up to breast-saving surgery or amputation were excluded. For patients with multiple examinations during the study period, all exami...

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Conventional radiographic imaging is accurate and moderately reliable in diagnosing union, and reliable but inaccurate in diagnosing nonunion of scaphoid waist fractures at 6 weeks follow-up.

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