Adding 3D automated ultrasound assists in screening women with dense breasts

A new study in Radiology has demonstrated an increase in cancer detection when using 3D automated breast ultrasound to supplement mammography among women with dense breasts—finding as many as 1.9 more cancers per 1,000 women screened than using mammography alone.

Supplemental screening with magnetic resonance imaging or ultrasonography after mammography has shown to increase the rate of early breast cancer detection in women with dense breasts, but the use of these advanced screening technologies has been limited to high-risk women with additional risk factors besides dense breast tissue.

The sensitivity of mammography for the detection of breast cancer is reported to be 85 percent, but as low as 48 percent in women with extremely dense breasts.

Led by Rachel F. Brem, MD, of George Washington University in Washington, D.C., researchers studied 15,318 women with dense breasts and no further risk factors. The study was conducted between 2009 and 2011 among 13 study facilities in the U.S.

Screening mammograms were read by 39 radiologists using the Breast Imaging Reporting and Data System (BI-RADS) classification.

Breast density was assessed by a radiologist and classified using BI-RADS density types: type 1 (almost entirely fat), type 2 (scattered fibroglandular densities), type 3 (heterogeneously dense) and type 4 (extremely dense). Women with density types 3 and 4 who were asymptomatic of breast cancer with no prior findings of the disease were included in the study.

Each study participant underwent standard digital mammography screening followed by an automated breast ultrasound. Images from the automated ultrasound were reconstructed and made three-dimensional for the radiologist to interpret.

A total of 2,301 women were recalled on the basis of the digital mammogram alone. Of these, 1,957 were also recalled on the basis of the combined mammography/automated breast ultrasound combined read.

Of the 13,107 women whose screening results were negative on the basis of screening mammography alone, 2,407 had a recall recommended on the basis of the combined mammography/automated breast ultrasound read.

Among all the women who were recalled, 112 women with breast cancer were identified—82 were identified by using screening mammography and cancers in an additional 30 women were identified using the automated breast ultrasound after no mammographic evidence of malignancy was found.

Brem and colleagues concluded that cancer detection was increased when using automatic breast ultrasound in addition to mammography among women with dense breasts.

“Improved detection through the use of [automated breast ultrasonography] supplemented to screening mammography alone has the potential to lead to earlier treatment and better prognosis in patients with dense breasts,” the researchers wrote.