Dense Breast Ultrasound Screening After Digital Mammography Versus After Digital Breast Tomosynthesis : American Journal of Roentgenology : Vol. 213, No. 6 (AJR)

December 2019, Volume 213, Number 6

« Previous Article | Next Article »

Women's Imaging

Original Research

Dense Breast Ultrasound Screening After Digital Mammography Versus After Digital Breast Tomosynthesis

Elizabeth H. Dibble¹, Tisha M. Singer¹, Nneka Jimoh¹, Grayson L. Baird^1,² and Ana P. Lourenco¹

Share Claim CREDIT

+ Affiliations:

¹Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Rhode Island Hospital, 3rd Fl Main Bldg, 593 Eddy St, Providence, RI 02903.

²Lifespan Biostatistics Core, Providence, RI.

Citation: American Journal of Roentgenology. 2019;213: 1397-1402. 10.2214/AJR.18.20748

ABSTRACT :

OBJECTIVE. The objective of this study was to compare the yield of dense breast ultrasound (US) screening after digital mammography (DM) versus after digital breast tomosyn-thesis (DBT).

MATERIALS AND METHODS. For this institutional review board–approved, HIPAA-compliant study, we retrospectively searched databases at two tertiary breast imaging centers and an office practice staffed by the same fellowship-trained breast radiologists for screening US examinations from October 1, 2014, to September 30, 2016. Prior DM versus DBT and screening US and pathology results were recorded. Mammographically occult cancers detected with US and additional benign lesions requiring biopsy were calculated. Differences between DM and DBT were compared using the two-sample proportions z test.

RESULTS. A total of 3183 screening breast US examinations were performed, 1434 (45.1%) after DM and 1668 (52.4%) after DBT. Of the 3183 examinations, 81 (2.5%) had no prior mammogram available. Of the 122 DM and DBT patients for whom biopsy or cyst aspiration was recommended (all BI-RADS assessment category 4 or BI-RADS assessment category 5 studies), 118 (96.7%) had biopsy or cyst aspiration results available. Of the 36 biopsies or aspirations after DM, 6 (16.7%) were malignant and 30 (83.3%) were benign; of the 82 biopsies or aspirations after DBT, 11 (13.4%) were malignant and 71 (86.6%) were benign (p = 0.8583). The additional cancer detection rate by US after DM was 5/1434 or 3.5 per 1000 women screened and after DBT was 5/1668 or 3.0 per 1000 women screened (p = 0.9999).

CONCLUSION. No significant difference in additional cancer detection rate was found with screening US after DM versus after DBT.

Keywords: dense breasts, digital breast tomosynthesis, early detection of cancer, mammography, ultrasound screening

Presented at the Radiological Society of North America 2017 annual meeting in Chicago, IL.

References

1. Nelson HD, Fu R, Cantor A, Pappas M, Daeges M, Humphrey L. Effectiveness of breast cancer screening: systematic review and meta-analysis to update the 2009 U.S. Preventive Services Task Force recommendation. Ann Intern Med 2016; 164:244–255 [Google Scholar]

2. Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology 2002; 225:165–175 [Google Scholar]

3. Checka CM, Chun JE, Schnabel FR, Lee J, Toth H. The relationship of mammographic density and age: implications for breast cancer screening. AJR 2012; 198:[web]W292–W295 [Abstract] [Google Scholar]

4. Harvey JA, Bovbjerg VE. Quantitative assessment of mammographic breast density: relationship with breast cancer risk. Radiology 2004; 230:29–41 [Google Scholar]

5. Yaghjyan L, Colditz GA, Collins LC, et al. Mammographic breast density and subsequent risk of breast cancer in postmenopausal women according to tumor characteristics. J Natl Cancer Inst 2011; 103:1179–1189 [Google Scholar]

6. Sala E, Solomon L, Warren R, et al. Size, node status and grade of breast tumours: association with mammographic parenchymal patterns. Eur Radiol 2000; 10:157–161 [Google Scholar]

7. Boyd NF, Guo H, Martin LJ, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med 2007; 356:227–236 [Google Scholar]

8. Arora N, King TA, Jacks LM, et al. Impact of breast density on the presenting features of malignancy. Ann Surg Oncol 2010; 17(suppl 3):211–218 [Google Scholar]

9. DenseBreast-info.org website. Legislation and regulation. densebreast-info.org/legislation.aspx. Accessed April 26, 2018 [Google Scholar]

10. Scheel JR, Lee JM, Sprague BL, Lee CI, Lehman CD. Screening ultrasound as an adjunct to mammography in women with mammographically dense breasts. Am J Obstet Gynecol 2015; 212:9–17 [Google Scholar]

11. Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09-41. Radiology 2012; 265:59–69 [Google Scholar]

12. Berg WA, Bandos AI, Mendelson EB, Lehrer D, Jong RA, Pisano ED. Ultrasound as the primary screening test for breast cancer: analysis from ACRIN 6666. J Natl Cancer Inst 2015; 108:djv367 [Google Scholar]

13. Weigert J, Steenbergen S. The Connecticut experiment: the role of ultrasound in the screening of women with dense breasts. Breast J 2012; 18:517–522 [Google Scholar]

14. Weigert JM. The Connecticut experiment; the third installment: 4 years of screening women with dense breasts with bilateral ultrasound. Breast J 2017; 23:34–39 [Google Scholar]

15. Parris T, Wakefield D, Frimmer H. Real world performance of screening breast ultrasound following enactment of Connecticut Bill 458. Breast J 2013; 19:64–70 [Google Scholar]

16. Ray KM, Turner E, Sickles EA, Joe BN. Suspicious findings at digital breast tomosynthesis occult to conventional digital mammography: imaging features and pathology findings. Breast J 2015; 21:538–542 [Google Scholar]

17. Berg WA, Blume JD, Cormack JB, et al.; ACRIN 6666 Investigators. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA 2008; 299:2151–2163 [Google Scholar]

18. Leong LC, Gogna A, Pant R, Ng FC, Sim LS. Supplementary breast ultrasound screening in Asian women with negative but dense mammograms: a pilot study. Ann Acad Med Singapore 2012; 41:432–439 [Google Scholar]

19. Youk JH, Kim EK, Kim MJ, Kwak JY, Son EJ. Performance of hand-held whole-breast ultrasound based on BI-RADS in women with mammographically negative dense breast. Eur Radiol 2011; 21:667–675 [Google Scholar]

20. Ooms EA, Zonderland HM, Eijkemans MJ, et al. Mammography: interobserver variability in breast density assessment. Breast 2007; 16:568–576 [Google Scholar]

21. Tagliafico AS, Tagliafico G, Cavagnetto F, Calabrese M, Houssami N. Estimation of percentage breast tissue density: comparison between digital mammography (2D full field digital mammography) and digital breast tomosynthesis according to different BI-RADS categories. Br J Radiol 2013; 86:20130255 [Google Scholar]

22. Sutton T, Reilly P, Johnson N, Garreau JR. Breast cancer in women under 50: most are not high risk. Am J Surg 2018; 215:848–851 [Google Scholar]

Address correspondence to E. H. Dibble ([email protected]).