The accuracy of mammography alone and in combination with clinical examination and cytology in the detection of breast cancer.

The accuracy of mammography alone and in combination with clinical examination and aspiration cytology was assessed in 402 patients who attended the Early Diagnostic Unit of the Royal Marsden Hospital, London. The sensitivities of mammography, clinical examination and cytology in identifying breast cancer were 76.9%, 81.7% and 63.5% respectively; the specificities of each test were 90.0%, 87.6% and 99.3%. The calculated sensitivity was increased to 96.2% if one positive test out of the three was regarded as an indication to undertake breast biopsy. If this approach was adopted the number of breast cancers missed would be two out of 104 and the yield of positive biopsies would be approximately one in four (27.6%). The implications of proceeding to breast biopsy on the basis of a single positive test are discussed.