Supplemental Ultrasound Screening Research Articles

Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.

There are no consensus guidelines for supplemental breast cancer screening with whole-breast ultrasound. However, criteria for women at high risk of mammography screening failures (interval invasive cancer or advanced cancer) have been identified. Mammography screening failure risk was evaluated among women undergoing supplemental ultrasound screening in clinical practice compared with women undergoing mammography alone. A total of 38,166 screening ultrasounds and 825,360 screening mammograms without supplemental screening were identified during 2014-2020 within three Breast Cancer Surveillance Consortium (BCSC) registries. Risk of interval invasive cancer and advanced cancer were determined using BCSC prediction models. High interval invasive breast cancer risk was defined as heterogeneously dense breasts and BCSC 5-year breast cancer risk ≥2.5% or extremely dense breasts and BCSC 5-year breast cancer risk ≥1.67%. Intermediate/high advanced cancer risk was defined as BCSC 6-year advanced breast cancer risk ≥0.38%. A total of 95.3% of 38,166 ultrasounds were among women with heterogeneously or extremely dense breasts, compared with 41.8% of 825,360 screening mammograms without supplemental screening (p<.0001). Among women with dense breasts, high interval invasive breast cancer risk was prevalent in 23.7% of screening ultrasounds compared with 18.5% of screening mammograms without supplemental imaging (adjusted odds ratio,1.35; 95% CI, 1.30-1.39); intermediate/high advanced cancer risk was prevalent in 32.0% of screening ultrasounds versus 30.5% of screening mammograms without supplemental screening (adjusted odds ratio,0.91; 95% CI, 0.89-0.94). Ultrasound screening was highly targeted to women with dense breasts, but only a modest proportion were at high mammography screening failure risk. A clinically significant proportion of women undergoing mammography screening alone were at high mammography screening failure risk.

Performance of Screening Ultrasonography as an Adjunct to Screening Mammography in Women Across the Spectrum of Breast Cancer Risk

Whole-breast ultrasonography has been advocated to supplement screening mammography to improve outcomes in women with dense breasts. To determine the performance of screening mammography plus screening ultrasonography compared with screening mammography alone in community practice. Observational cohort study. Two Breast Cancer Surveillance Consortium registries provided prospectively collected data on screening mammography with vs without same-day breast ultrasonography from January 1, 2000, to December 31, 2013. The dates of analysis were March 2014 to December 2018. A total of 6081 screening mammography plus same-day screening ultrasonography examinations in 3386 women were propensity score matched 1:5 to 30 062 screening mammograms without screening ultrasonography in 15 176 women from a sample of 113 293 mammograms. Exclusion criteria included a personal history of breast cancer and self-reported breast symptoms. Screening mammography with vs without screening ultrasonography. Cancer detection rate and rates of interval cancer, false-positive biopsy recommendation, short-interval follow-up, and positive predictive value of biopsy recommendation were estimated and compared using log binomial regression. Screening mammography with vs without ultrasonography examinations was performed more often in women with dense breasts (74.3% [n = 4317 of 5810] vs 35.9% [n = 39 928 of 111 306] in the overall sample), in women who were younger than 50 years (49.7% [n = 3022 of 6081] vs 31.7% [n = 16 897 of 112 462]), and in women with a family history of breast cancer (42.9% [n = 2595 of 6055] vs 15.0% [n = 16 897 of 112 462]). While 21.4% (n = 1154 of 5392) of screening ultrasonography examinations were performed in women with high or very high (≥2.50%) Breast Cancer Surveillance Consortium 5-year risk scores, 53.6% (n = 2889 of 5392) had low or average (<1.67%) risk. Comparing mammography plus ultrasonography with mammography alone, the cancer detection rate was similar at 5.4 vs 5.5 per 1000 screens (adjusted relative risk [RR], 1.14; 95% CI, 0.76-1.68), as were interval cancer rates at 1.5 vs 1.9 per 1000 screens (RR, 0.67; 95% CI, 0.33-1.37). The false-positive biopsy rates were significantly higher at 52.0 vs 22.2 per 1000 screens (RR, 2.23; 95% CI, 1.93-2.58), as was short-interval follow-up at 3.9% vs 1.1% (RR, 3.10; 95% CI, 2.60-3.70). The positive predictive value of biopsy recommendation was significantly lower at 9.5% vs 21.4% (RR, 0.50; 95% CI, 0.35-0.71). In a relatively young population of women at low, intermediate, and high breast cancer risk, these results suggest that the benefits of supplemental ultrasonography screening may not outweigh associated harms.

Supplemental ultrasound screening in patients with a history of lobular neoplasia.

To investigate the role of ultrasound (US) screening as an adjunct to annual mammography (M) in breast cancer detection in women with a history of lobular neoplasia (LN) diagnosed following core needle or excisional biopsy. A retrospective review of our database was performed between 11/2006 and 11/2011 to identify patients diagnosed with LN, and underwent annual screening. Patients with a lifetime risk >20% per risk modeling were excluded. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and cancer detection rate (CDR) of each screening test were identified. Cancer type and detection modality were recorded. A total of 100 patients who had M and/or US screening were included. Mean patient age was 54.7years (range 33-83). All 100 patients underwent a mean of 3.9 rounds of screening M and 93 (93%) received US screening (mean 3.3 rounds). Of 93 patients who received both M and US screening, 12 (13%) were diagnosed with breast cancer. Mammographic CDR was 4%. Incremental US CDR was 6.5%. The sensitivity, specificity, and NPV for M screening alone was 33% (10%, 65%), 77% (67%, 85%), and 89% (80%, 95%), respectively. US and mammography screening had a combined sensitivity: 83% (52%, 98%), Specificity: 72% (62%, 81%), NPV: 97% (89%, 100%). Supplemental US screening resulted in a significant increase in sensitivity, yielding 6.5% incremental CDR in this high-risk patient subgroup that does not fulfill ACS high-risk MRI screening criteria.

Automated breast ultrasound: basic principles and emerging clinical applications.

Automated breast ultrasound (ABUS) is a recently introduced ultrasonography technique, developed with the purpose to standardize breast ultrasonography and overcome some limitations of handheld ultrasound (HHUS), such as operator dependence and the considerable amount of medical time necessary to perform and interpret HHUS. This new ultrasonography technique separates the moment of image acquisition (that may be performed also by a technician) from that of its interpretation, increasing reproducibility, reducing operator-dependence and physician time. Moreover, multiplanar reconstructions, especially the coronal view, introduce new diagnostic information. ABUS, with those advantages, has the potential to be used as an adjunctive tool to screening mammography, especially in the dense breast, where mammography has a relatively low sensitivity. Women's awareness of risks related to breast density is a hot topic, especially in the USA where legislative breast density notification laws increase the demand for supplemental ultrasound screening. Therefore, ABUS might have the potential to respond to this need. The purpose of this article is to present a summary of current state-of-the-art of ABUS technology and applications, with an emphasis on breast cancer screening. This article discusses also how to overcome some ABUS limitations, in order to be familiar with the new technique.

Supplemental Ultrasonography Screening for Women With Dense Breasts

Supplemental Ultrasonography Screening for Women With Dense Breasts

Benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts.

Many states have laws requiring mammography facilities to tell women with dense breasts and negative results on screening mammography to discuss supplemental screening tests with their providers. The most readily available supplemental screening method is ultrasonography, but little is known about its effectiveness. To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. Comparative modeling with 3 validated simulation models. Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; and medical literature. Contemporary cohort of women eligible for routine screening. Lifetime. Payer. Supplemental ultrasonography screening for women with dense breasts after a negative screening mammography result. Breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs. Supplemental ultrasonography screening after a negative mammography result for women aged 50 to 74 years with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models, 0.14 to 0.75), gained 1.7 QALYs (range, 0.9 to 4.7), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained (range, $112,000 to $766,000). Supplemental ultrasonography screening for only women with extremely dense breasts cost $246,000 per QALY gained (range, $74,000 to $535,000). The conclusions were not sensitive to ultrasonography performance characteristics, screening frequency, or starting age. Provider costs for coordinating supplemental ultrasonography were not considered. Supplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits. National Cancer Institute.

Global challenges of cancer imaging: perspective from different parts of the world: Asia

Asia accounts for about 60% of the world's population and half the global burden of cancer [1]. Due to the diverse economic development across the Asian continent, countries have highly variable health services development and healthcare infrastructure. Thus, there is disparity in access to services, especially resource intensive cancer management. All countries in Asia, except Japan are defined by the UN as 'less developed regions' and this reflects the limited resources in general. This presentation aims to describe the demographic characteristics of cancer in Asia, and highlight the challenges and main advancements of cancer imaging across this region. Lung cancer is the most common cancer in men (35.2/100,000 persons) and breast cancer the most common cancer in women (29.1/100,000 women) in Asia. The incidence rate of breast cancer in Asia is about 1/3 compared to North America (NA) and Western Europe (WE), although it is on a steady rise. However, the five year prevalence rate is manifold lower indicating that in proportion, there are fewer cancer survivors in Asia. With the exceptions of Japan, South Korea and Taiwan, resources in most countries are inadequate for population-based organised screening mammography programmes. However, it is less clear if organised screening would be a cost-effective programme in Asia, due to the lower incidence rate as well as reduced sensitivity of mammography in Asian women with higher density breast tissue [2], and there is evidence that supplemental ultrasound screening increases the sensitivity for cancer detection in women with dense breasts [3]. Notably, in South East Asia (SEA) and East Asia (EA) compared to the rest of the world, the incidences of liver cancer, oesophageal cancer, stomach cancer and nasopharyngeal cancer are relatively high, although on the decline. Liver cancer is the second and third most common cancer in men in SEA and EA respectively, and fifth most common cancer in women. More than 70% of the new cases of liver cancer are from Asia, of which 50% are from China. Recent studies have advanced the use of gadolinium ethoxybenzyl dimeglumine (Gd-EOB-DTPA) enhanced MRI for its superior sensitivity for the detection of hepatocellular carcinoma, especially small tumors [4], and 11C-acetate PET imaging for detection of well-differentiated tumors [5]. Oesophageal cancer is the fifth most common cancer in EA men. Asia accounts to about 75% of new cases, specifically the 'asian oesophageal cancer belt' that extends from Turkey to Mongolia and Western/Northern China. The majority of these are squamous cell carcinoma in histology. Studies have found 18F-Fluorodeoxyglucose (FDG) PET to be useful in disease staging (particularly upstaging), and predictive of outcome of neo-adjuvant chemotherapy and disease survival [6]. Nasopharyngeal carcinoma is the sixth and fourteenth most common cancer in men across SEA and EA respectively. 80% of new cases are from this region, and are focussed around Southern China, Taiwan and SEA. Current research has evaluated the roles of diffusion MRI for tissue characterisation [7] and 18F-FDG PET for prognostication [8]. In recent years the cancer burden in Asia and its developing countries has surged, and is forecasted to continue to rise. Resources for the provision and development of diagnostic imaging which plays an essential role in early detection and management of cancer must be supported and strengthened across the region.

0494: Ultrasound (US) - Elastography of Suspicious Abnormal Breast Lesions Detected by Supplemental Screening US

0494: Ultrasound (US) - Elastography of Suspicious Abnormal Breast Lesions Detected by Supplemental Screening US

IMAGING OF DEVELOPMENTAL DYSPLASIA OF THE HIP

Careful clinical examination remains the primary and most important way of diagnosing developmental dysplasia of the hip (DDH) in newborn infants. Repeated examinations during the first year are important to diagnose DDH subsequent to the newborn period. Sonography can detect cases of clinically silent DDH. Targeting high-risk infants for supplemental ultrasound screening at 4 to 6 weeks of age increases diagnosis of DDH and at significantly less expense than widespread screening. When sonography is not available, a pelvis radiograph at 3 months should be obtained in high-risk infants. Sonography also is used to monitor hip position and acetabular development in children undergoing harness treatment. Computed tomography and magnetic resonance imaging are reserved for children with more severe dysplasia, often as preoperative studies to help orthopedic surgeons to select the appropriate procedure.