Screening breast ultrasound supplies definitive diagnoses in dense tissue

Screening sonography of women with dense breast tissue can find cancers that mammography misses, and the radiation-free modality is specific enough to keep unneeded biopsies in check, according to the authors of a study published online June 28 in the Journal of Ultrasound Medicine.

Stamatia Destounis, MD, of five-site Elizabeth Wende Breast Care in Upstate New York and colleagues reviewed patient charts from a 32-month period ending in August 2015.

During that period, Wende Breast Care performed 195,982 screening mammography exams, informing 42.5 percent (83,234 patients) that their breast tissue was heterogeneously dense or extremely dense.

Of these latter, 4,898 women had 5,434 screening sonographic exams.

For the study, Destounis and co-authors specifically reviewed cases to identify those with findings on sonography only.

They found that most of the sonograms, 95.7 percent, yielded a BI-RADS 1 (negative) or 2 (benign) finding.

Meanwhile a total of 101 lesions were designated BI-RADS 3 (probably benign), while 134 lesions were given a BI-RADS 4 (suspicious abnormality) or 5 (highly suspicious of malignancy) designation.

In all, 100 suspicious lesions showed up on sonography only and led to tissue sampling.

Some 18 malignancies were diagnosed, and all were invasive.

The authors report their analysis thus showed the screening ultrasound to have a positive predictive value of 18.0 percent, with an overall biopsy rate of 2.0 percent and a cancer detection rate of 3.3 per 1,000.

“The results of our continued evaluation of our screening sonography program confirm that screening breast sonography in women with dense breast tissue can detect otherwise occult malignancy, with a low biopsy rate,” Destounis et al. conclude.