Utility of supplemental screening with breast ultrasound in asymptomatic women with dense breast tissue who are not at high risk for breast cancer

Abstract

Objective: To assess the results of an initial round of supplemental screening with hand-held bilateral breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue who are not at high risk for breast cancer. Materials and Methods: A retrospective, Health Insurance Portability and Accountability Act compliant, Institutional Research Board approved study was performed at a single academic tertiary breast center. Informed consent was waived. A systematic review of the breast imaging center database was conducted to identify and retrieve data for all asymptomatic women, who were found to have heterogeneously dense or extremely dense breast tissue on screening bilateral mammograms performed from July 1, 2010 through June 30, 2012 and who received a mammographic final assessment American College of Radiology's (ACR) Breast Imaging Reporting and Data System (BI-RADS) category 1 or BI-RADS category 2. Hand-held screening ultrasound was performed initially by a technologist followed by a radiologist. Chi-square and t-test were used and statistical significance was considered at P< 0.05. Results: A total of 1210 women were identified. Of these, 394 underwent the offered supplemental screening ultrasound. BI-RADS category 1 or 2 was assigned to 323 women (81.9%). BI-RADS category 3 was assigned to 50 women (12.9%). A total of 26 biopsies/aspirations were recommended and performed in 26 women (6.6%). The most common finding for which biopsy was recommended was a solid mass (88.5%) with an average size of 0.9 cm (0.5–1.7 cm). Most frequent pathology result was fibroadenoma (60.8%). No carcinoma was found. Conclusion: Our data support the reported occurrence of a relatively high number of false positives at supplemental screening with breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue, who are not at a high risk of developing breast cancer, and suggests that caution is necessary in establishing wide implementation of this type of supplemental screening for all women with dense breast tissue without considering other risk factors for breast cancer.

Keywords

Breast ultrasound - dense breasts - screening

Publikationsverlauf

Artikel online veröffentlicht:
27. Juli 2021

• References

• 1 Breast Imaging Reporting and Data System. 4th ed. Reston: American College of Radiology; 2003.
• 2 Carney PA, Miglioretti DL, Yankaskas BC, Kerlikowske K, Rosenberg R, Rutter CM, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med 2003;138:168-75.
• 3 Boyd NF, Guo H, Martin LJ, Sun L, Stone J, Fishell E, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007;356:227-36.
• 4 Tice JA, Cummings SR, Smith-Bindman R, Ichikawa L, Barlow WE, Kerlikowske K. Using clinical factors and mammographic breast density to estimate breast cancer risk: Development and validation of a new predictive model. Ann Intern Med 2008;148:337-47.
• 5 Pisano ED, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, et al. Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group. Diagnostic performance of digital versus film mammography for breast-cancer screening. N Engl J Med 2005;353:1773-83.
• 6 Kaplan SS. Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology 2001;221:641-9.
• 7 Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and US and evaluation of factors that influence them: An analysis of 27,825 patient evaluations. Radiology 2002;225:165-75.
• 8 Crystal P, Strano SD, Shcharynski S, Koretz MJ. Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol 2003;181:177-82.
• 9 Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Böhm-Vélez M, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 2008;299:2151-63.
• 10 Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, Barr RG, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 2012;307:1394-404.
• 11 Corsetti V, Houssami N, Ghirardi M, Ferrari A, Speziani M, Bellarosa S, et al. Evidence of the effect of adjunct ultrasound screening in women with mammography-negative dense breasts: Interval breast cancers at 1 year follow-up. Eur J Cancer 2011;47:1021-6.
• 12 Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: Initial experience with Connecticut Public Act 09-41. Radiology 2012;265:59-69.
• 13 Leong LC, Gogna A, Pant R, Ng FC, Sim LS. Supplementary breast ultrasound screening in Asian women with negative but dense mammograms-A pilot study. Ann Acad Med Singapore 2012;41:432-9.
• 14 Youk JH, Kim EK, Kim MJ, Kwak JY, Son EJ. Performance of hand-held whole-breast ultrasound based on BI-RADS in women with mammographically negative dense breast. Eur Radiol 2011;21:667-75.
• 15 Brancato B, Bonardi R, Catarzi S, Iacconi C, Risso G, Taschini R, et al. Negligible advantages and excess costs of routine addition of breast ultrasonography to mammography in dense breasts. Tumori 2007;93:562-6.
• 16 Girardi V, Tonegutti M, Ciatto S, Bonetti F. Breast ultrasound in 22,131 asymptomatic women with negative mammography. Breast 2013;22:806-9.
• 17 Parris T, Wakefield D, Frimmer H. Real world performance of screening breast ultrasound following enactment of Connecticut Bill 458. Breast J 2013;19:64-70.
• 18 Weigert J, Steenbergen S. The Connecticut experiment: The role of ultrasound in the screening of women with dense breasts. Breast J 2012;18:517-22.
• 19 Are you Dense? Advocacy. D.E.N.S.E. ® State Efforts. 2014; Available from: http://www.areyoudenseadvocacy.org/dense/. [Last accessed on 2015 Aug 30].
• 20 Sprague BL, Gangnon RE, Burt V, Trentham-Dietz A, Hampton JM, Wellman RD, et al. Prevalence of mammographically dense breasts in the United States. J Natl Cancer Inst 2014;106.
• 21 American College of Radiology. ACR Appropriateness Criteria®. 2012. Breast cancer screening. Available from: https://acsearch.acr.org/docs/70910/Narrative/. [Last accessed on 2015 Aug 30].
• 22 Kopans DB. Basic physics and doubts about relationship between mammographically determined tissue density and breast cancer risk. Radiology 2008;246:348-53.
• 23 Lee CH. Radiologic Screening for Breast Cancer: Current Controversies. Curr Radiol Rep 2014;2:34.
• 24 Position Statements. ACR Statement on Reporting Breast Density in Mammography Reports and Patient Summaries. April 24, 2012. Available from: http://www.acr.org/About-Us/Media-Center/Position-Statements/Position-Statements-Folder/Statement-on-Reporting-Breast-Density-in-Mammography-Reports-and-Patient-Summaries. [Last accessed on 2015 Aug 21].
• 25 Lauby-Secretan B, Scoccianti C, Loomis D, Benbrahim-Tallaa L, Bouvard V, Bianchini F, et al. International Agency for Research on Cancer Handbook Working Group. Breast-cancer screening--viewpoint of the IARC Working Group. N Engl J Med 2015;372:2353-8.
• 26 Sprague BL, Stout NK, Schechter C, van Ravesteyn NT, Cevik M, Alagoz O, et al. Benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. Ann Intern Med 2015;162:157-66.
• 27 Kerlikowske K, Zhu W, Tosteson AN, Sprague BL, Tice JA, Lehman CD, et al. Breast Cancer Surveillance Consortium. Identifying women with dense breasts at high risk for interval cancer: A cohort study. Ann Intern Med 2015;162:673-81.