Can mechanical imaging increase the specificity of mammography screening?

Magnus Dustler,Sophia Zackrisson,Håkan Brorson,Daniel Förnvik,Ingvar Andersson,Pontus Timberg,Hannie Petersson,Anders Tingberg

doi:10.1007/s00330-016-4723-6

Magnus Dustler, Sophia Zackrisson + Show 6 more

Open Access

https://doi.org/10.1007/s00330-016-4723-6

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Journal: European Radiology	Publication Date: Jan 20, 2017
Citations: 10	License type: open-access

Affiliation: Skåne University Hospital, Lund University

Abstract

ObjectivesThis study aimed to investigate the effects of adding adjunct mechanical imaging to mammography breast screening. We hypothesized that mechanical imaging could detect increased local pressure caused by both malignant and benign breast lesions and that a pressure threshold for malignancy could be established. The impact of this on breast screening was investigated with regard to reductions in recall and biopsy rates.Methods155 women recalled from breast screening were included in the study, which was approved by the regional ethical review board (dnr 2013/620). Mechanical imaging readings were acquired of the symptomatic breast. The relative mean pressure on the suspicious area (RMPA) was defined and a threshold for malignancy was established.ResultsBiopsy-proven invasive cancers had a median RMPA of 3.0 (interquartile range (IQR) = 3.7), significantly different from biopsy-proven benign at 1.3 (IQR = 1.0) and non-biopsied cases at 1.0 (IQR = 1.3) (P < 0.001). The lowest RMPA for invasive cancer was 1.4, with 23 biopsy-proven benign and 33 non-biopsied cases being below this limit. Had these women not been recalled, recall rates would have been reduced by 36% and biopsy rates by 32%.ConclusionsIf implemented in a screening situation, this may substantially lower the number of false positives.Key Points• Mechanical imaging is used as an adjunct to mammography in breast screening.• A threshold pressure can be established for malignant breast cancer.• Recalls and biopsies can be substantially reduced.

Highlights

In addition to mammography, ultrasonography is often used in the work-up of recalled women
The J-START trial investigated ultrasonography as an adjunct to mammography in screening on 72,988 women, and found it to be effective for detecting more cancers at an earlier stage, but did not assess its economic efficacy [31,32,33]
The impact of adding adjunct Mechanical imaging (MI) to screening was estimated in terms of reduced recall rates, assuming that the radiologist would recommend recall based on the screening mammogram and mark the location of the suspicious finding, with an actual recall assumed to be made only if the local pressure on that feature exceeded the threshold for malignancy

Summary

Introduction

Ultrasonography is often used in the work-up of recalled women. It is effective at differentiating malignant and benign findings [25,26,27]. General screening with ultrasound is not implemented due to a lack of cost-effectiveness, related to examination time and the need for a trained operator to carry out the procedure, and the high false-positive rate [28,29,30]. The J-START trial investigated ultrasonography as an adjunct to mammography in screening on 72,988 women, and found it to be effective for detecting more cancers at an earlier stage, but did not assess its economic efficacy [31,32,33]. Various automatic and semi-automatic ultrasound systems exist, but their performance in screening has not been established [34].

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