Scientific Session 08 — Breast - UltrasoundTuesday, May 2, 2017
2395. Whole Breast Screening Ultrasound at a Single Institution: A 2673 Patient Experience
Chhadia S1, Huang J1,2, Harmon J1*, Patel S1, Kirshenbaum K1 1. Illinois Masonic Medical Center, Chicago, IL; 2. Pennsylvania Hospital, Philadelphia, PA
Address correspondence to J. Huang (firstname.lastname@example.org)
Objective: The purpose of this study is to determine the impact of whole breast screening ultrasound performed by dedicated breast sonographers using a standardized screening protocol to detect additional cancers in patients with dense breasts and otherwise normal mammograms.
Materials and Methods: A review of all whole breast screening ultrasound examinations performed at a single institution between January 1, 2014, and December 31, 2015, was conducted and included a total of 2673 female patients (mean age, 54 years old; age range, 17–90 years old) with dense (heterogeneously or extremely dense) breasts and otherwise normal mammograms. Whole breast screening ultrasound examinations were performed by five dedicated breast sonographers with a mean of 7 years of experience with our standardized screening protocol, which includes an image obtained at every clock position, the retroareolar region, and axillary tail of each breast. Images were reviewed by one of five board-certified radiologists with a mean of 13 years of breast imaging experience who then assigned a BI-RADS category of 0, 1, 2, or 3 to each patient. Total number of additional cancers diagnosed, frequency of each BI-RADS category, number of biopsies performed, and positive predictive value of biopsies were analyzed.
Results: In our cohort, whole breast screening ultrasound enabled detection of an additional 4.9 cancers per 1000 patients screened. A total of 76 biopsies were performed, resulting in a total of 13 diagnosed cancers: 11 invasive ductal carcinomas, one invasive lobular carcinoma, and one invasive mammary carcinoma. The positive predictive value was 17.1%, and the frequencies of BI-RADS categories 0, 1, 2, and 3 were 12.9%, 25.9%, 36.1%, and 25.1%, respectively.
Conclusion: Whole breast screening ultrasound performed by an experienced breast sonographer using our standardized screening protocol resulted in a positive predictive value of 17.1%. Other similar studies such as the American College of Radiology Imaging Network 6666 trial using physician-performed ultrasound demonstrated a positive predictive value of 8.9%. Whether this difference is statistically significant, and, if so, what additional underlying factors account for the difference warrants further investigation. Whole breast screening ultrasound performed by dedicated breast sonographers can play a vital role in detecting cancers missed by mammography and should be considered an important adjunct imaging tool.