Screening Breast Ultrasound

8/16/2019 Screening Breast Ultrasound

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Screening Breast

Ultrasound: Past,Present, and Future

Preceptor : dr.Dessy Wimelda, Sp.Rad

By : Muhammad Brahmana Putra


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OB!"#$%!

#his article discusses &reastultrasound 'or the detection o' &reastcancer in the screening en(ironment, as)ell as strategies 'or integratingscreening &reast ultrasound, including

automated &reast ultrasound.


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"O*"+US$O*

Breast density is an increasinglypertinent issue in &reast cancer diagnosis.

Breast density results in a decrease in thesensiti(ity o' mammography 'or cancerdetection, )ith a signicant increase in theris- o' &reast cancer. Ultrasound detects

additional cancers.


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Mammography isrecommended 'or )omen

&eginning at age / years

Breast cancer

#he second leading

cause o' cancerdeath in )omen inthe United States

#he mostcommonlydiagnosed

malignancy in)omen )orld)ide


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Mammography is an imper'ecttool and is not e0ually

e1ecti(e in all )omen.

#he sensiti(ity o'

mammography

23 4

#he sensti(ity in )omen)ith dense &reast tissue

5.2 67.4

#he decreased a&ility o' mammography todetect &reast cancer is a result o' the lac- o'contrast &et)een the 8)hite9 &reast tissue andthe 8)hite9 &reast cancer (isualiedmammographically


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Women )ith e;tremely dense &reastsalso ha(e a 4.7-fold increased risk o'de(eloping &reast cancer compared )ith)omen )ith 'atty


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• review the data sho)ing the impacto' screening &reast ultrasound suchthat ultrasound can &e implemented as

a screening tool in )omen )ith dense&reast tissue.

• Is it eective to screen )omen )ithdense &reast parenchyma )ith )hole<&reast ultrasound@


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$n a single, Aaplan

!(aluated the per'ormance o' screeningultrasound in patients )ith B$27? )omen )ith negati(emammograms. total o' >/? procedures )ereper'ormed in 5 patients &ecause o' suspicioussonographic ndings.

• Eielding si; &reast cancers in (e patients.

• Positi(e predicti(e (alue PP%G H >>.24.

• #his resulted in a diagnostic yield o' 3 additional

cancers per 1000 women.


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#he sonographically detected cancers )ereidentied a'ter the mammographicallydetected cancers )ere already detected.

#hese )ere incremental cancers, )hichwould not have been detected without

the addition of screening ultrasound.

$n this early study, Aaplan 'ound thatultrasound could &e used as a screening

tool to detect small in(asi(e early


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In 00! "olb et al.

$n(estigated the per'ormance o' screeningmammography, screening ultrasound, andphysical e;amination in the detection o' &reast

cancer in >C,35 )omen.Aol& et al. analyed the e1ect o' age, &reastdensity and hormonal status on mammographicsensiti(ity.

Breast density )as the most signicantpredictor o' decreased mammographicsensiti(ity.


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#he sensiti(ity 'or &reast cancer in

)omen )ith B$4.

#he PP% :• ?/.34 )ith screening ultrasound

alone.• C3.24 )ith mammography.


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$n ?//C, +econte et al

)omen )ith dense B$


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$n ?//2, Berg et al.

Pu&lished the results o' the rst yearo' the merican "ollege o' Radiology$maging *et)or- "R$*G 7777 trial.

#his )as a prospecti(e randomiedmultiinstitutional trial o' ?2/ )omen toaccess the use o' screening ultrasoundin addition to mammography using astandardied protocol.


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#hat study 'ound :

• #he diagnostic yield o' &reast cancer o'4. per 1000 )omen screened.

• #he &iopsy rates :

•

.4 'or mammography.• 2.>4 'or ultrasound alone.

• >/.4 'or &oth.

•

#he PP% :• ??.74 'or mammography alone.

• >>.?4 'or mammography plus hand<held screening ultrasound.


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in ?/>?, Berg andcolleaguesReported years ? and C 'ollo)>> &reast cancers )eredetected during the study

• 3 3C4G )ere detected )ith

mammography alone.• C? ?4G )ere detected )ith ultrasound

alone.

• 24G )ere detected &y MR$ alone.


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• $n years ? and C, an additional 3.7 cancers)ere detected )ith screening &reastultrasound per 1000 women screened.

• #he sensiti(ity :

•

mammography com&ined )ith ultrasoundH574

• mammography alone H 3?4

• Specicity :

• mammography alone H >4• mammography plus ultrasound H 24.


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• #he PP% :• Mammography

• First year )as ?/4.

• ? and C years C24.• Mammography plus handheld

ultrasound

•

First year >>4.• ? and C yearrs >74.


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Studies ha(e sho)n thatscreening &reast ultrasound in

)omen )ith dense &reasttissue is e1ecti(e in detectingmammographically occult

predominantly small node<negati(e &reast cancer.


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#he "R$* 7777 study 'ound that an

a(erage o' > minutes o' physician time)as re0uired 'or handheld ultrasound&reast screening, not includinginterpretation or reporting time. #his is a

signicant )or-Io) issue )henconsidering screening &reast ultrasound.

#o harness the potential o' ultrasoundscreening in a )or-Io) eJcientapproach, automated breastultrasound was developed.


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utomated &reastultrasoundis a no(el approach 'or screening &reastultrasound in )hich image ac0uisition isuncoupled 'rom the interpretation


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utomated &reast ultrasound allo)s :

•

$mpro(ed consistency and reproduci&ility o'images.

• Minimies operator dependence.

• ids )ith inclusion o' the entirety o' the

&reast.• Does not re0uire physician time 'or image

ac0uisition.

• llo)s the physician to interpret the entire

study and identi'y the suspicious lesions.• llo)s re(ie) o' the study at either the time

o' ac0uisition or a later time.


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"ell# et al

Studied the a&ility o' automated )hole


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nother study &y Aelly etal.$n(estigated the a&ility o' automated&reast ultrasound used &y communit#radiologists to impro(e &reast cancerdetection in )omen )ith dense &reasttissue.

• #he sensiti(ity increase 'rom 3/4 to 2>4.

• and all 'ound >76?4 more cancers thane(en the &est per'orming mammographer.


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• #he "R$* 7777 trial and eight othernon&linded screening ultrasound trials'rom >3 through ?//C sho) promise

)ith ultrasound screening &ecause o'increased cancer detection and thesmall sie o' cancers detected.


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2


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• Mediolateralo&li0ue (ie)s.

"ircle denotesmole.


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• "ancer is seen on ultrasound. Pathologicanalysis re(ealed ductal carcinoma insitu.

3 ld i h


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3


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• Mediolateralo&li0ue (ie)s."ircle denotes

mole.


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• #hree.3


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•

#rans(erse imagereconstructed incoronal plane sho)ssame >.3


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•

$n summary, screening &reastultrasound may &e a solution tothe as


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#han- Eou

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Screening Breast Ultrasound