Comparative study of mammography and breast ultrasound in the diagnosis of breast cancer in young women: A meta-analysis

This meta-analysis evaluates the diagnostic performance of mammography and breast ultrasound for detecting breast cancer in young women (≤45 years). A comprehensive literature search was conducted across major databases (PubMed, EMBASE, Cochrane Library, and Web of Science) from January 2000 to April 2024. Eleven observational studies (n = 9567 participants, 12,043 breast lesions) were included. Diagnostic performance metrics, including true positives (TP), false positives (FP), true negatives (TN), and false negatives (FN), were extracted. Pooled sensitivity, specificity, and diagnostic odds ratios (DOR) were calculated using STATA 17.0. The results indicated that breast ultrasound exhibited significantly higher sensitivity compared to mammography. The pooled sensitivity of ultrasound was 88 % (95 % confidence intervals (CI): 85–90 %), while that of mammography was 76 % (95 % CI: 72–79 %), with a significant difference (P < 0.01). In terms of specificity, both modalities showed comparable performance. The pooled specificity of ultrasound was 87 % (95 % CI: 84–89 %), and for mammography, it was 82 % (95 % CI: 78–86 %), with no statistically significant difference (P = 0.13). The 95 % CI for specificity overlap between 84 and 86 %, suggesting that the lack of statistical significance may reflect limited power rather than a true absence of difference. Confidence intervals (US: 84–89 % vs. MMG: 78–86 %) show minimal overlap, suggesting potential clinical significance despite statistical non-significance. Subgroup analyses further revealed that ultrasound had a particularly strong performance in Asian populations and regions with a higher prevalence of dense breast tissue. The odds ratio (OR) for sensitivity in Asian cohorts was 3.02 (95 % CI: 2.30–3.97), compared to 2.15 in Western cohorts, highlighting the significant advantage of ultrasound in these settings. Breast ultrasound is supported as a preferred initial imaging modality for breast cancer screening in young women, particularly in regions with high breast density. While mammography may serve as a supplementary tool, ultrasound offers significant advantages in sensitivity. This study addresses gaps in evidence for young women, emphasizing the need for tailored diagnostic strategies.