Breast ultrasound in the screening and diagnosis of breast cancer.

Abstract Abstract #MS3-1 Six single center and two multicenter studies of screening breast ultrasound have shown a consistent detection yield of 3-5 per 1000 for supplemental screening breast ultrasound after mammography. The vast majority of these additional cancers seen only on ultrasound are invasive, with mean tumor size of 9-11 mm across series, and, where reported, approximately 90% are node negative. Supplemental detection is mainly seen when the breast tissue is dense. Screening ultrasound carries a substantial risk of false positives, with 9-11% of biopsies prompted by ultrasound proving malignant. In the first year of the ACRIN 6666 protocol, 1 in 40 women had an unnecessary biopsy due to mammography, compared to 1 in 10 after both mammography and ultrasound. Modeling to predict impact on mortality and cost-effectiveness of screening ultrasound is in progress, and results of incidence screens in ACRIN 6666 will be forthcoming. Ultrasound is widely used to characterize abnormalities seen on mammography and to guide biopsy, including biopsy of MRI-depicted suspicious findings. At the time of biopsy of suspicious masses, ultrasound of the ipsilateral axilla can help identify and guide FNAB of suspicious node(s) if present. In the setting of widespread malignant-appearing calcifications, ultrasound can help identify a mass which may represent an invasive component. Ultrasound has also been shown to be more accurate in identifying the source of abnormal nipple discharge than galactography. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr MS3-1.