Ultrasound Breast Screens Useful in Selected Women

CHICAGO--Citing findings from radiological studies performed onmore than 10,000 women, Paula Gordon, MD, suggests periodic ultrasoundexamination of the breast in addition to mammography for womenat high risk of breast cancer and who have mammographically densebreasts.

She also believes that ultrasonographers should scan the entirebreast in women whose mammograms exhibit a lump or some othersuspicious finding rather than follow the common practice of scanningonly the lump and the surrounding tissue.

Ultrasonography of the full breast takes only a few minutes longerthan a spot scan, and it does not appreciably add to the costof the exam. However, it can uncover unsuspected cancer, saidDr. Gordon, clinical associate professor of radiology, Universityof British Columbia, Vancouver, Canada.

Ultrasound should not take the place of mammography as a breastcancer screening tool, Dr. Gordon said at the annual meeting ofthe Radiological Society of North America. "Ultrasound doesnot show microcalcifications, for example, which are early signsof cancer that show up very well on mammography," she explained.

However, ultrasound could be an adjunct to mammography for certaingroups of women, she advised. One group consists of women whohave no symptoms of breast cancer but who have a strong familyhistory of the disease or a prior personal history of breast cancerand who have radiographically dense breasts.

Another group includes women with breast cancer who are beingconsidered for conservative surgery. "Ultrasound can helpdetermine if other areas of undiagnosed cancer may exist in thebreast, thereby helping to determine how extensive surgical removalshould be," she said.

Dr. Gordon reached these conclusions after completing a studyof breast ultrasound examinations performed on 10,362 women. Ultrasoundidentified a total of 3,533 solid tumors, 37% of which had notbeen seen previously on mammography studies or palpated duringphysical examination.

Of the 328 breast malignancies that were confirmed in the study,37 (more than 11%) were diagnosed by ultrasound alone. These malignanciesranged in size from 4 mm to 2.5 cm, and they represented 2.8%of the tumors that had not been found on mammographic or physicalexamination.

"Mammography remains the gold standard for breast cancerscreening, and, for the vast majority of women, no further examis recommended if a mammogram is negative. However, for a smallgroup of women at high risk for breast cancer, adding ultrasoundto mammography as a screen may improve diagnosis and greatly increasetheir peace of mind," Dr. Gordon said.