Screen High Risk Women with US + Mammo JAMA Article Concludes
A study published in this week’s issue of the Journal of the American Medical Association indicates that another screening approach for women at high risk of developing breast cancer should incorporate both ultrasound and mammography. This is an alternative to, instead, completing MRI scanning for this cohort.
The study, completed by the American College of Radiology Imaging Network (ACRIN), recruited 2637 women. Over half the women, ranging in age from 25 to 91, had a personal history of breast cancer. The other participants were considered high risk based on a BRCA mutation, previous radiation to the chest or mediastinum, Claus or Gail model criteria, or a previous biopsy that was atypical.
Studies were reviewed and performed independently. Almost all the participants had either extremely dense or heterogeneous parenchyma in at least one quadrant.
Forty patients were positive for breast cancer. Of those with disease, eight were identified with both screening approaches, 12 were found on ultrasound alone, and 12 were also found with mammography alone. Nine of the cancers were not found with either screening method.
The diagnostic yield of mammography was 7.6 per 1000. This rate increased to 11.8 per 1000 when both ultrasound and mammography information was combined. Diagnostic accuracy was 0.78 and increased to 0.91 with the combined approach.
The data published indicates that the combination of the two imaging methods increases diagnostic yield by 50 percent. The downside, however, of this approach, is that the rate of false positives increases significantly. Ultrasound has a known higher rate of false-positives compared to mammography. The combined approach had an even higher rate of false-positives.
The research team indicates that while MRI is essentially equivalent in terms of disease sensitivity and specificity, ultrasound is significantly less expensive to complete. As well, it may be the preferred modality for patients. Determining the appropriate methods to screen different patients may be best crafted considering the array of individual factors.
May 16, 2008 Related topics: Imaging, Diagnostic, Radiology