What is the role of ultrasonography in breast cancer screening?

Updated: Apr 10, 2019
  • Author: Erin V Newton, MD; Chief Editor: Marie Catherine Lee, MD, FACS  more...
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Ultrasonography has become a widely available and useful adjunct to mammography in the clinical setting. Ultrasound is generally used to assist the clinical examination of a suspicious lesion detected on mammography or physical examination. As a screening device, ultrasonography is limited by a number of factors, most notably by a failure to detect microcalcifications and by poor specificity (34%).

Originally, ultrasonography was used primarily as a relatively inexpensive and effective method of differentiating cystic breast masses, which did not require sampling, from solid breast masses that were usually examined with biopsy; in many cases, the results of these biopsies were benign. However, it is now well established that ultrasonography also provides valuable information about the nature and extent of solid masses and other breast lesions.

This imaging technique is also useful in the guidance of biopsies and therapeutic procedures; research is currently under way to evaluate its role in cancer screening.

Although mammography is an effective screening tool, data suggest that it is often less sensitive in detecting cancer in mammographically dense breast tissue. Kolb et al and Buchberger et al found that when performed carefully, ultrasonography may be useful in detecting occult breast cancer in dense breasts. [14, 15]

Ultrasonography is generally acknowledged to be a highly operator-dependent modality that requires a skilled practitioner, high-quality examinations, and state-of-the-art equipment. In view of the results of these studies, a prospective, multicenter study is clearly needed to examine the role of this imaging modality in breast cancer screening.

A large multicenter study supported by the Avon Foundation and the National Institutes of Health (NIH) was created through the American College of Radiology Imaging Network (ACRIN). [16] In this project, a protocol to assess the efficacy of screening breast ultrasonography is being implemented in 14 imaging centers to better define the role of this modality in breast cancer screening. (More information is available on the ACRIN Web site.)

In September 2012, the FDA approved the first ultrasound system, the somo-v Automated Breast Ultrasound System (ABUS), for breast cancer screening specifically in women with dense breast tissue. [17] ABUS is indicated as an adjunct to standard mammography for women with a negative mammogram, no breast cancer symptoms and no previous breast intervention such as surgery or biopsy.

Currently, it is recommended that ultrasonographic screening for breast disease be reserved for special situations, such as for highly anxious patients who request it and for women who have a history of mammographically occult carcinoma.

See Ultrasonography in Breast Cancer for more information.

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