Ultrasound alone effective for diagnosing noncalcified masses recalled from screening DBT: Study
USA: A recent study in the American Journal of Roentgenology has found ultrasound (US) alone to be effective in the diagnostic evaluation of noncalcified masses recalled from digital breast tomosynthesis (DBT) exams. Further, the authors suggested diagnostic mammography to be the best for asymmetries, without the need for additional ultrasound. However, architectural distortions still warrant diagnostic mammography and US.
Previous studies have shown the diagnostic performance of DBT to be equivalent to diagnostic mammography. However, there is no clarity on the value of additional mammographic views in diagnostic evaluations. Jessica H. Porembka, Department of Radiology, The University of Texas Southwestern Medical Center, Dallas, TX, and colleagues, therefore, aimed to compare the performance of diagnostic breast ultrasound alone to combined US and diagnostic mammography for specific noncalcified recalled abnormalities detected on screening DBT.
For this purpose, the researchers performed a prospective HIPAA-compliant, IRB–approved study with a single-arm management strategy. As a part of the study protocol, women recalled for noncalcified lesions from screening DBT underwent initial diagnostic US. Additional diagnostic mammography was performed at the radiologist's discretion.
Decisions of imaging assessment were determined by BI-RADS assessments. Management recommendations, biopsy outcomes, and follow-up were recorded using case report forms completed the day of the diagnostic evaluation and stored in the electronic medical record.
430 recalled noncalcified lesions in 399 women (mean age, 60 years ± 12 years) were included from July 2017 to June 2019.
Key findings include:
- US alone was performed on 71.2% (306/430) of lesions, while US with diagnostic mammography was performed on 28.8% (124/430).
- Of recalled lesions, 93.7% of masses (178/190), 60.0% (51/85) focal asymmetries, 46.1% (53/115) asymmetries, 69.2% (9/13) developing asymmetries and 55.6% (15/27) architectural distortions were evaluated with US alone.
- Of 93 lesions that underwent needle biopsy, 40.9% (38/93) were cancers, all invasive.
- Thirty-five of 38 cancers (92.1%) were evaluated by US alone, while three (7.9%) were evaluated with US and diagnostic mammography.
- At median follow-up of 25 months, six cancers were identified (three with US alone and three with US plus diagnostic mammography groups) in patients with initially benign workup.
- US alone had two false-negative cancers (one architectural distortion identified at follow-up and one mass biopsied stereotactically at initial detection).
Based on the findings, the authors suggest that radiologists should consider performing US first for DBT-recalled noncalcified masses. Omitting diagnostic mammography when US is negative has a low false-negative rate, they noted.
Reference:
American Journal of Roentgenology: -. 10.2214/AJR.21.26700
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