Utility of supplemental screening with breast ultrasound in asymptomatic women with dense breast tissue who are not at high risk for breast cancer

Abstract

Objective: To assess the results of an initial round of supplemental screening with hand-held bilateral breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue who are not at high risk for breast cancer.

Materials and methods: A retrospective, Health Insurance Portability and Accountability Act compliant, Institutional Research Board approved study was performed at a single academic tertiary breast center. Informed consent was waived. A systematic review of the breast imaging center database was conducted to identify and retrieve data for all asymptomatic women, who were found to have heterogeneously dense or extremely dense breast tissue on screening bilateral mammograms performed from July 1, 2010 through June 30, 2012 and who received a mammographic final assessment American College of Radiology's (ACR) Breast Imaging Reporting and Data System (BI-RADS) category 1 or BI-RADS category 2. Hand-held screening ultrasound was performed initially by a technologist followed by a radiologist. Chi-square and t-test were used and statistical significance was considered at P < 0.05.

Results: A total of 1210 women were identified. Of these, 394 underwent the offered supplemental screening ultrasound. BI-RADS category 1 or 2 was assigned to 323 women (81.9%). BI-RADS category 3 was assigned to 50 women (12.9%). A total of 26 biopsies/aspirations were recommended and performed in 26 women (6.6%). The most common finding for which biopsy was recommended was a solid mass (88.5%) with an average size of 0.9 cm (0.5-1.7 cm). Most frequent pathology result was fibroadenoma (60.8%). No carcinoma was found.

Conclusion: Our data support the reported occurrence of a relatively high number of false positives at supplemental screening with breast ultrasound following a negative screening mammogram in asymptomatic women with dense breast tissue, who are not at a high risk of developing breast cancer, and suggests that caution is necessary in establishing wide implementation of this type of supplemental screening for all women with dense breast tissue without considering other risk factors for breast cancer.

Keywords: Breast ultrasound; dense breasts; screening.

Figure 1 (A and B)

(A) Bilateral Mammogram Cranio Caudal view-Heterogeneously dense breasts (B) Bilateral Mammogram Medio Lateral Oblique view-Heterogeneously dense breasts

Figure 2 (A and B)

(A) Bilateral Mammogram Cranio Caudal view-Extremely dense breasts (B) Bilateral Mammogram Medio Lateral Oblique view-Extremely dense breasts

Figure 3

Bilateral screening breast ultrasound-Category BIRADS 1. Negative

Figure 4 (A and B)

(A) Bilateral screening breast ultrasound showing a simple cyst in a patient with breast implants-Category BIRADS 2. Benign (B) Bilateral screening breast ultrasound showing a simple cyst with color doppler in the same patient with breast implants- Category BIRADS 2. Benign

Figure 5 (A-C)

(A) Bilateral screening breast ultrasound showing a benign appearing mass, likely a fibroadenoma for which a six month follow up ultrasound was recommended- Category BIRADS 3. Probably Benign (B) Bilateral screening breast ultrasound showing a benign appearing mass, likely a fibroadenoma for which a six month follow up ultrasound was recommended- Category BIRADS 3. Probably Benign (C) Bilateral screening breast ultrasound showing a benign appearing mass, likely a fibroadenoma with color doppler for which a six month follow up ultrasound was recommended- Category BIRADS 3. Probably Benign

Figure 6 (A-C)

(A) Bilateral screening breast ultrasound showing a round, heterogenous mass with mixed solid and cystic components and irregular margins. Anti radial plane. Biopsy was recommended and performed. Results showed benign papilloma- Category BIRADS 4. Suspicious (B) Bilateral screening breast ultrasound showing a round, heterogenous mass with mixed solid and cystic components and irregular margins. Radial plane. Biopsy was recommended and performed. Results showed benign papilloma- Category BIRADS 4. Suspicious (C) Bilateral screening breast ultrasound showing a round, heterogenous mass with mixed solid and cystic components and irregular margins. With color doppler. Biopsy was recommended and performed. Results showed benign papilloma- Category BIRADS 4. Suspicious

Figure 7 (A and B)

(A) Bilateral screening breast ultrasound showing a palpable mass in the right breast 9:00 axis. Biopsy was performed because it was palpable. Results showed fibroadenoma- Category BIRADS 4. Suspicious (B) Bilateral screening breast ultrasound showing a palpable mass in the right breast 9:00 axis with color doppler. Biopsy was performed because it was palpable. Results showed fibroadenoma- Category BIRADS 4. Suspicious