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Ultrasound comparable to mammography for breast cancer detection
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The use of ultrasound appeared to detect breast cancer at a rate comparable to mammography, with greater identification of invasive and node-negative cancers, according to results from the ACRIN 6666 trial.
However, ultrasound appeared associated with a higher rate of false positives, results showed.
Wendie A. Berg
Breast cancer incidence is increasing, but mammography is not widely available in all parts of the world.
Thus, Wendie A. Berg, MD, PhD, FACR, professor of radiology at University of Pittsburgh Medical Center’s Magee-Womens Hospital, and colleagues sought to compare performance characteristics of ultrasound to screen for breast cancer.
Berg and colleagues recruited 2,662 women (median age, 55 years; range, 25-91) from 20 sites in the United States, Canada and Argentina.
The women underwent three annual examinations with ultrasound plus either film-screen mammography (n = 4,351) or digital mammography (n = 3,122). They had biopsy or 12-month follow-up.
Cancer detection, recall and positive predictive values served as study endpoints.
The researchers reported 111 breast cancer events. These included 89 (80.2%) invasive cancers (median size, 12 cm).
The median number of ultrasound screenings vs. mammography screenings to detect one cancer appeared comparable (129 vs. 129), as did the overall cancer detection rate (52.3% vs. 53.2%).
However, significantly more invasive cancers were detected using ultrasound screening (91.4% vs. 69.5%; P < .001), and those detected were more likely to be node-negative (64.2% vs. 43.9%; P = .003).
However, after 4,814 incidence screens in years 2 and 3, ultrasound appeared associated with higher recall rates (10.7% vs. 9.4%; P = .03) and biopsy rates (5.5% vs 2%; P < .001), as well as a lower positive predictive value (11.7% vs. 38.1%; P < .001).
The researchers acknowledged that a larger study would be needed to confirm a correlation between ultrasound screening and greater sensitivity to invasive cancers. Further, they noted that all study participants had at least one risk factor for breast cancer, which may have confounded results.
“Although further validation is warranted, these results suggest that screening ultrasound could be a viable alternative to mammography in countries lacking organized screening, particularly with availability of low-cost, portable ultrasound system,” Berg and colleagues wrote. “Where mammography is available, ultrasound should be seen as a supplement test for women with dense breasts who do not meet high-risk criteria for screening MRI and for high-risk women with dense breasts who are unable to tolerate MRI.” – by Cameron Kelsall
Disclosure: The researchers report funding from The Avon Foundation for Women and the NCI.
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