Noncalcified lesions observed on digital breast tomosynthesis exams signal that additional imaging is necessary to rule out malignancy. But rather than obtaining additional mammographic views, research suggests using ultrasound alone may be sufficient.
The American Journal of Roentgenology recently published a study that dives deeper into the ultrasound versus mammography discussion. For the research, doctors examined 430 recalled noncalcified lesions in 399 women to determine whether ultrasound alone is a suitable recall tool compared to incorporating ultrasound in conjunction with additional mammographic views.
“We hypothesized that omitting diagnostic mammography for the evaluation of recalled noncalcified abnormalities from screening DBT might help greatly reduce non-additive diagnostic mammography without missing cancers,” corresponding author, Jessica H. Porembka, MD, with the Department of Radiology at the University of Texas Southwestern Medical Center, and co-authors explained.
Ultrasound alone was performed on 306 lesions, while it was used in addition to mammography for 124 lesions. Needle biopsy was performed on 93 lesions, 38 of which were found to be invasive cancers. Ultrasound alone detected 92% of the cancers (35 out of 38). The other three were discovered using US and additional mammographic views.
“Performing US first in the evaluation of noncalcified masses recalled on screening DBT can help reduce the number of women receiving non-additive diagnostic mammography,” the doctors noted. “Because noncalcified lesions make up a large number of recalled lesions, downstream omission of radiation exposure could be significant.”
Although the results of the study suggest that ultrasound alone is sufficient for recall imaging of most noncalcified lesions, the authors caution that not all lesions are created equal. Some findings, like asymmetries, may require diagnostic mammography, while architectural distortion is best visualized with both ultrasound and mammography combined, or even with contrast-enhanced MRI.
You can view the detailed research in the American Journal of Roentgenology.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.