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. 2012 Oct;265(1):59-69.
doi: 10.1148/radiol.12120621. Epub 2012 Jun 21.

Screening US in Patients With Mammographically Dense Breasts: Initial Experience With Connecticut Public Act 09-41

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Screening US in Patients With Mammographically Dense Breasts: Initial Experience With Connecticut Public Act 09-41

Regina J Hooley et al. Radiology. .

Abstract

Purpose: To determine performance and utilization of screening breast ultrasonography (US) in women with dense breast tissue who underwent additional screening breast US in the 1st year since implementation of Connecticut Public Act 09-41 requiring radiologists to inform patients with heterogeneous or extremely dense breasts at mammography that they may benefit from such examination.

Materials and methods: Informed consent was waived for this institutional review board-approved, HIPAA-compliant retrospective review of 935 women with dense breasts at mammography who subsequently underwent handheld screening and whole-breast US from October 1, 2009, through September 30, 2010.

Results: Of 935 women, 614 (65.7%) were at low risk, 149 (15.9%) were at intermediate risk, and 87 (9.3%) were at high risk for breast cancer. Of the screening breast US examinations, in 701 (75.0%), results were classified as Breast Imaging Reporting and Data System (BI-RADS) category 1 or 2; in 187 (20.0%), results were classified as BI-RADS category 3; and in 47 (5.0%), results were classified as BI-RADS category 4. Of 63 aspirations or biopsies recommended and performed in 53 patients, in nine, lesions were BI-RADS category 3, and in 54, lesions were BI-RADS category 4. Among 63 biopsies and aspirations, three lesions were malignant (all BI-RADS category 4, diagnosed with biopsy). All three cancers were smaller than 1 cm, were found in postmenopausal patients, and were solid masses. One cancer was found in each risk group. In 44 of 935 (4.7%) patients, examination results were false-positive. Overall positive predictive value (PPV) for biopsy or aspirations performed in patients with BI-RADS category 4 masses was 6.5% (three of 46; 95% confidence interval [CI]: 1.7%, 19%). Overall cancer detection rate was 3.2 cancers per 1000 women screened (three of 935; 95% CI: 0.8 cancers per 1000 women screened, 10 cancers per 1000 women screened).

Conclusion: Technologist-performed handheld screening breast US offered to women in the general population with dense breasts can aid detection of small mammographically occult breast cancers (cancer detection rate, 0.8-10 cancers per 1000 women screened), although the overall PPV is low.

Comment in

  • To seek perfection or not? That is the question.
    D'Orsi CJ, Sickles EA. D'Orsi CJ, et al. Radiology. 2012 Oct;265(1):9-11. doi: 10.1148/radiol.12121515. Epub 2012 Aug 28. Radiology. 2012. PMID: 22929336 No abstract available.
  • Breast density legislation.
    Hall FM. Hall FM. Radiology. 2013 Mar;266(3):997-8. doi: 10.1148/radiol.12121953. Radiology. 2013. PMID: 23431234 No abstract available.
  • Response.
    Hooley RJ, Greenberg K, Stackhouse RM, Geisel J, Butler R, Philpotts LE. Hooley RJ, et al. Radiology. 2013 Mar;266(3):998-9. Radiology. 2013. PMID: 23550287 No abstract available.
  • Density and breast cancer risk.
    Harvey JA, Yaffe MJ, D'Orsi C, Sickles EA. Harvey JA, et al. Radiology. 2013 May;267(2):657-8. doi: 10.1148/radiol.13122477. Radiology. 2013. PMID: 23610099 No abstract available.
  • Response.
    D'Orsi C, Sickles EA. D'Orsi C, et al. Radiology. 2013 May;267(2):658-9. Radiology. 2013. PMID: 23741743 No abstract available.

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