Screening breast ultrasound & beyond
Lisa Fratt, Editor
Last week, Texas Governor Rick Perry signed HB 2102 into law, which requires mammography facilities to provide women information about breast density.

The Texas legislation follows a similar law passed in 2009 in Connecticut, which requires mammography providers to inform women with dense breasts that they may benefit from additional breast screening exams, such as ultrasound or MRI.

Connecticut also requires insurance companies to cover ultrasound screening if a mammogram demonstrates heterogeneous or dense breast tissue based on BIRADS (Breast Imaging Reporting and Data System) classification.

The Connecticut law appears to be fueling an uptick in facilities offering breast screening ultrasound. In addition, both laws, as well as pending legislation in California, are generating a burst of awareness among women.

The combination of legislation and patient-focused publicity programs, such as the website, are likely to push further initiatives across the U.S.

Meanwhile, on the clinical front, measuring breast density is not without challenges. A poster presentation at RSNA 2010, for example, indicated great variation among reading radiologists—even at the same institution—in reporting breast density.

The researchers reported “great variability” in breast density reporting among eight radiologists reading 250 exams. In approximately 26 percent of exams, there was total agreement on density. In approximately 48 percent of exams, the majority (7/8 and 6/8) agreed on density. In approximately 17 percent, five of eight radiologists agreed. The remaining 9 percent of mammograms had 50 percent or less concordance of density reporting.

“We knew there would be some variations because we’re aware of our partners’ tendencies, but we didn’t realize that the differences would be so great,” study author Stephanie L. van Colen, DO, from Caritas Good Samaritan Medical Center in Brockton, Mass., told Health Imaging News.

Technology may help, and last fall, the FDA approved breast density calculating software for use with two vendors’ mammography systems.

And while screening ultrasound is in the spotlight, the modality holds promise for other breast imaging applications. For example, single-dose, intraoperative breast radiation therapy hinges on the use of operative ultrasound to localize the target.

Further down on the clinical horizon is contrast-enhanced breast ultrasound with molecularly targeted microbubbles. In the March issue of Radiology, a preclinical study indicated that the model could define promising imaging targets for early cancer detection and treatment monitoring.

Which breast ultrasound applications are you investigating? Please let us know.

Lisa Fratt