Breast ultrasound spares young women unnecessary biopsies

Targeted breast ultrasound is a safe and effective alternative to biopsies, and it can be used by radiologists to alleviate anxiety that patients may have about breast cancer screening, according to two studies presented Wednesday at the 2009 RSNA meeting.

“Breast imaging with ultrasound is a tool that can be used to decrease the harms and costs associated with unnecessary surgery,” said senior investigator Dr. Constance D. Lehman, vice chair of radiology at the University of Washington in Seattle.

Ultrasound was used to effectively differentiate cancerous masses from benign lumps. Advantages of targeted breast ultrasound include that it is both less invasive and less expensive than biopsy.

In the first study, Lehman and colleagues examined 1091 lesions in 830 female patients under the age of 30 who underwent ultrasound mainly for breast signs and symptoms. Three of the patients (0.4%) were found to have cancer, and each of these women had suspicious lumps, according to their ultrasound results.

“The overall incidence of cancer in these women under 30 is very low. Ultrasound is a 100% sensitivity tool in this setting, supporting its use as a primary imaging modality,” Lehman said.

The second study examined 1327 cases in 1032 women between the ages of 30 and 39 who underwent both ultrasound and mammography. Two percent of the cases were malignant and were all detected by ultrasound. However, none were detected by the mammogram alone, calling into question the added benefit of mammography in this setting.

Lehman also discussed the possibility of using ultrasound to test BI-RADS 3 lesions that are probably benign lumps, rather than doing a biopsy or performing surgery. In the first study, a third of the patients with BI-RADS 3 lesions opted to undergo tissue sampling, and none were found to be malignant.

“With these data we can be much more reassuring to patients on the very low likelihood of malignancy in these probably-benign lesions. In fact, in our hands it was zero percent,” said Lehman, who is also director of breast imaging at the Seattle Cancer Care Alliance.

According to Lehman, radiologists can use targeted breast ultrasound to directly challenge the anxieties associated with fear of breast cancer.

“This is an example where we have confidence our imaging tools can really give women much more security in these areas,” she said.