RSNA: Targeted breast US in young women reduces need for biopsy

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CHICAGO--Targeting suspicious areas of the breast with ultrasound can reduce the need for biopsies in young women, according to the findings of two studies presented Wednesday at the annual meeting of the Radiological Society of North America (RSNA)..

According to Constance Lehman, MD, PhD, professor and vice chair of radiology at the University of Washington and director of imaging at the Seattle Cancer Care Alliance, the results of the studies are timely considering the controversial mammography guidelines recently released by the U.S. Preventive Services Task Force (USPSTF).

“The USPSTF recommendations that women not perform breast self examination confused a lot of women,” said Lehman. “For most women, particularly those women who’ve had a friend who has identified her cancer because she noticed a lump in her breast, and brought it to the attention of her doctor, these recommendations are very concerning. Yet we do want to acknowledge that many women have a great deal of anxiety and sometimes receive unnecessary surgery when they’ve examined their breasts and found an abnormality. We think imaging can better guide us . . . to reduce the harm that can be associated with a self-breast exam. “

Lehman said that while the risk of breast cancer in the under age 40 population is low—cancer is diagnosed in just 2 percent of those cases of women who present with lumps or localized pain —“it is not zero.” Cancer occurs in young women and it frequently comes to a radiologist’s attention, Lehman said, because either the woman or her doctor identified a lump in a breast.

Ultrasound is a very valuable tool in evaluating these women--diagnosing cancers and reducing unnecessary surgeries," said Lehman.

Researchers conducted two studies in which targeted ultrasound was used to distinguish between potential cancerous masses and benign findings in women who had detected lumps or other areas of concern in their breasts.

The first study included 1,123 ultrasound examinations of women under the age of 30, while the second included 1,577 ultrasound examinations of women ages 30 to 39. For the first group, 1,091 lesions in 830 patients comprised the analysis set.

Biopsy was recommended in 174 patients and performed on 168, which means biopsy was not recommended on about 80 percent of patients. Three of the patients were diagnosed with cancer, meaning the overall cancer rate was 0.4 percent.

“We think with these data we can be much more reassuring to patients on the very low likelihood of malignancy in these probably benign lesions,” said Lehman. “The overall incidence of cancer in these women under 30 is very low. Ultrasound is a very, very sensitive tool, supporting its use as the primary imaging modality."

In the second group of women between the ages of 30 and 39, of the 1,577 ultrasounds studied, 1,327 cases in 1,032 patients comprised the analysis set. Lehman pointed out that for the age group the American College of Radiology recommends that mammography be performed in addition to ultrasound..

According to the researchers, outcomes were benign in 1,301 cases and malignant in the other 26 (2 percent of the cases). They found that all of the cancers at the site of clinical concern were identified by ultrasound and none by mammography alone, although mammography did result in the detection of one additional malignancy in an asymptomatic area of the breast of one woman.

The researchers concluded that breast imaging is warranted in women 30 to 39 years of age, “due to the small, but very real risk of malignancy,” said Lehman. She added that ultrasound has high sensitivity in evaluating areas of clinical concern, while the added value of mammography is not as clear and deserves further study.

“Because cancer does occur in this age group," said Lehman, "ultrasound is a valuable tool in evaluating these regions of focal signs or symptoms in women under 40, because the high sensitivity supports the use of ultrasound over surgical excision of lumps in young women, which is currently a common practice in the United States. Ultrasound is a tool that can be used to decrease the harm associated with unnecessary surgery and also decrease the cost associated with unnecessary surgery."