Targeted breast ultrasound could reduce need for invasive biopsies for women under 40


Targeted breast ultrasound could reduce need for invasive biopsies for women under 40

Two new studies from the US that explored the effectiveness of targeted breast ultrasound showed it was able successfully to tell the difference between benign and cancerous tumors in young women with lumps or other specific, localized signs or symptoms of breast cancer; so much so that the researchers recommended this method as a "tool of choice" for evaluating palpable lumps in women under 40, thus reducing the need for invasive biopsies.

Both studies were led by Constance D Lehman, professor and vice chair of radiology at the University of Washington and director of imaging at the Seattle Cancer Care Alliance, who presented the findings on Wednesday at the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), that is taking place from Nov 29 to Dec 4, in Chicago.

Lehman said that high-quality breast ultrasound is a safe, effective and less expensive alternative to invasive biopsies in young women.

"We don't want to be overly aggressive with this population," she said.

"Surgical excision or needle biopsy of tissue can be painful, expensive and frequently unnecessary in these age groups, which have very low rates of malignancies," explained Lehman.

"In most cases, monitoring with targeted ultrasound is a very safe alternative," she added.

In both studies Lehman and colleagues analysed the effectiveness of targeted ultrasound in distinguishing between benign and cancerous masses in young women who had detected breast lumps or expressed concern about specific locations in their breasts.

The first study included 1,123 ultrasound exams of women under 30 and the second included 1,577 ultrasound exams of women aged 30 to 39. In both cases the goal was to evaluate ultrasound exam versus alternatives, with mammogram being the focus of the first study and biopsy the focus of the second.

The data came from medical records of breast ultrasound exams performed between January 2002 and August 2006. Lehman and colleagues reviewed individual records and picked out the ultrasound exams that had been performed to evaluate "a focal breast sign or symptom such as lump or pain". They counted each area of focal clinical concern evaluated with ultrasound as a separate case (so there could have been more than one per patient).

They classed a BI-RAD assessment of 4 or 5 as a positive identification of cancer and 1, 2, or 3 as a negative. (BI-RAD, or Breast Imaging Reporting and Data System, is a standard used by radiologists to interpret and report the results of mammography, ultrasound, and MRI used in breast cancer screening and diagnosis).

The researchers then compared the ultrasound assessment to outcomes obtained through "biopsy, 24 months of imaging follow-up, and/or linkage with the Cancer Surveillance System (CSS) tumor registry".

Lehman said that across both studies, targeted ultrasound identified all instances of cancer at the site of clinical concern, and negative findings correctly identified benign changes in the breast.

There was one instance where targeted ultrasound failed to find a malignant mass, but this was an unsuspected lesion outside of the target exam area: it was identified by a full breast mammogram.

The results also showed that among women aged 30 to 39, malignancy incidence was 2 per cent, and in women under 30 it was 0.4 per cent.

Commenting on the clinical relevance of the first study, the researchers suggested that:

"Women under 30 years of age with focal breast signs or symptoms should be evaluated by targeted US [ultrasound]. If a mass is identified, surveillance may be preferred over biopsy."

And for the second study they commented that:

"In women 30-39 years of age with focal breast signs or symptoms, US [ultrasound] has a high sensitivity while the added value of mammography is less evident."

Lehman said that ultrasound should be the diagnostic tool of choice for examining young women seeking a diagnosis of breast lumps and other focal signs and symptoms.

"It is time we used ultrasound to reduce unnecessary morbidity and costs associated with more aggressive invasive approaches," she said.

"Outcomes of Targeted Ultrasound Evaluation in Women Under 30 Years of Age with Focal Breast Signs or Symptoms."

Presented by: Constance D Lehman.

Study co-authors: Vilert Loving, Wendy B DeMartini, Peter R Eby, Robert L Gutierrez, and Sue Peacock.

Code: SSK02-08, Session: Breast Imaging (Ultrasound).

Radiological Society of North America, 95th Scientific Assembly and Annual Meeting, Nov 29 - Dec 4, 2009, Chicago.

" Contribution of Mammography to Ultrasound Evaluation of Women 30 to 39 Years of Age with Focal Breast Signs or Symptoms."

Presented by: Constance D Lehman.

Study co-authors: Michael Portillo, Wendy B DeMartini, Peter R Eby, Robert L Gutierrez, and Franklin Liu.

Code: SSK02-09, Session: Breast Imaging (Ultrasound).

Radiological Society of North America, 95th Scientific Assembly and Annual Meeting, Nov 29 - Dec 4, 2009, Chicago.

Source: RSNA, National Cancer Institute.

MAMMOGRAMS INCREASE RISK OF BREAST CANCER, HERE ARE THE SAFE ALTERNATIVES FOR BREAST EXAMS (Video Medical And Professional 2018).

Section Issues On Medicine: Women health