Ultrasound Examination of Breast Masses Useful in Women Under 40

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Two studies were presented today at the annual meeting of the Radiological Society of North America (RSNA) meeting in Chicago which highlighted the use of targeted breast ultrasound as a safe means to reduce biopsies for women under age 40.

"By performing high-quality breast ultrasound, we can reduce the number of expensive and avoidable invasive diagnostic procedures in young women," said senior author Constance D. Lehman, M.D., Ph.D., professor and vice chair of radiology at the University of Washington and director of imaging at the Seattle Cancer Care Alliance. "We don’t want to be overly aggressive with this population."

The first study was a retrospective review of medical records identifying all breast US examinations performed from 2/1/02 to 8/30/06 in women under 30 years of age. Clinical exam and history were noted. Outcomes were determined by biopsy, 24 months of imaging follow-up, and/or linkage with the Cancer Surveillance System (CSS) tumor registry.

This study included 1,123 US examinations, 1091 lesions in 830 patients comprised the analysis set. The mean patient age was 24 (range 12-29) years. Biopsy was recommended in 174 patients and performed in 168 patients. Three of the 168 patients who underwent biopsy were diagnosed with cancer, for a positive biopsy rate of 1.8%. No additional cancers were identified with imaging follow-up or CSS linkage. The overall cancer yield was 0.4% (3/830). Sensitivity of US was noted to be 100% (3/3) and specificity was 79.3% (656/827).

The second study looked at women aged 30-39 with focal breast signs or symptoms. The study was a retrospective review of their radiology database which identified all breast US examinations performed from 1/1/02-8/31/06 in women 30-39 years of age (1327 cases in 1032 patients). Clinical exam and history were noted, as were radiologic modalities used (US and mammography vs. US alone). Benign versus malignant outcomes were determined by biopsy or 24 months of follow-up imaging and through linkage with the Cancer Surveillance System (CSS) tumor registry. The sensitivities and specificities of mammography and US were calculated.

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Benign outcomes were noted in 1301/1327 (98%) and malignant in 26/1328 (2%) cases. None of the malignant cancers were identified by mammography alone, but were by US and mammography.

US and mammography were used in 1207/1327 (91%) cases. The sensitivity of US at the area of clinical concern was 100% and of mammography was 64%. Specificities of US and mammography were 89% and 94%, respectively. Mammography did result in detection of one additional malignancy in an asymptomatic area of the breast in a 32 year old subsequently found to have a BRCA2 gene mutation.

"Surgical excision or needle biopsy of tissue can be painful, expensive and frequently unnecessary in these age groups, which have very low rates of malignancies," Dr. Lehman said. "In most cases, monitoring with targeted ultrasound is a very safe alternative."

She added that ultrasound should be the diagnostic tool of choice for young women seeking care for breast lumps and other suspicious focal signs and symptoms. "It is time we used ultrasound to reduce unnecessary morbidity and costs associated with more aggressive invasive approaches," Dr. Lehman said.

“Outcomes of Targeted Ultrasound Evaluation in Women Under 30 Years of Age with Focal Breast Signs or Symptoms”; Coauthors are Vilert Loving, M.D., Wendy B. DeMartini, M.D., Peter R. Eby, M.D., Robert L. Gutierrez, M.D., and Sue Peacock, M.Sc.

“Contribution of Mammography to Ultrasound Evaluation of Women 30 to 39 Years of Age with Focal Breast Signs or Symptoms”; co-authors are Michael Portillo, M.D., Wendy B. DeMartini, M.D., Peter R. Eby, M.D., Robert L. Gutierrez, M.D., and Franklin Liu, M.D.

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