Objective. To reevaluate the diagnostic value of breast imaging in the diagnosis of breast cancer in areas where health resources are limited. Methods. Patients were women presenting with breast lumps in two university-affiliated tertiary hospitals, Thailand, during 2006 and 2010. Clinical data were abstracted from the breast cancer registration database and patient records. The diagnostic predictive ability of ultrasonography and mammography was obtained from logistic regression analysis and presented with areas under the receiver operating characteristics (AuROCs) curves. Results. Among 3129 breast lumps (3069 women), 854 were diagnosed with breast cancer by certified pathologists. Age and size of lumps alone already predicted cancer correctly in 77.45% (AuROC = 77.45). Additional ultrasonography increased the prediction to 96.22% ( ). Additional mammography also increased the prediction to 95.99% ( ). Performing both imaging modalities did not increase the prediction clinically (0.01%–0.24%). More accurate prediction (2.07%–2.21%) may be added by fine needle aspiration cytology (FNAC). Conclusions. Breast imaging is still valuable in settings where health resources are limited. Single breast imaging (only either ultrasonography or mammography) is adequate for cancer diagnosis. It is therefore unnecessary to perform both imaging modalities. Accuracy of the diagnosis may be improved by FNAC, if available. 1. Introduction Breast cancer is increasingly common in women worldwide. It is one of the leading causes of death among female malignancies [1]. The incidence varies from region to region, more in developed countries (>80 per 100,000 populations) than in developing countries (<40 per 100,000 populations). In southeast Asian women, it was 31.0 per 100,000 populations [2]. Cancer of the breast in Thailand is the highest among all female cancers and is continuously rising. The incidence increased from 34.4 to 40.6 per 100,000 populations during 2006 to 2009. The mortality also increased from 6.3 to 7.3 per 100,000 populations in the corresponding years [3]. The standard diagnosis of breast cancer recommended triple diagnostic investigations [4], comprising (1) clinical breast examination; (2) breast imaging, ultrasonography, or mammography, (3) cytopathologic with fine needle aspiration cytology (FNAC) or histopathologic findings with a core needle biopsy with cutting needle biopsy. The same recommendation was also used by The National Institute of Cancer of Thailand, for women presenting with breast lumps [5]. Ultrasonography is recommended in women
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