Keywords:
Cancer, Efficacy studies, Ultrasound, Mammography, Breast
Authors:
G. G. N. Mello, A. P. C. Moura, V. L. N. Aguillar, L. F. Chala, M. Aracava; São paulo, são paulo/BR
DOI:
10.1594/ecr2018/C-0445
Aims and objectives
Increase breast density reduces mammographic accuracy and supplemental screening is recommended,
mainly with ultrasound (WBUS) and/or tomosynthesis (DBT).
Both methods increase invasive cancer detection,
when added to digital mammography (DM).
Single and multicenter studies have demonstrated that ultrasound screening can detect small additional cancers - median of 4.2/1000 exams- but with a low PPV for biopsies (Table 1)
On the other hand prospective and retrospective trials have shown that digital breast tomosynthesis (DBT) also detects additional invasive cancers -median of 2.0 /1000- mainly as architectural distortion,
being dependent on the contrast between breast tissue and lesion (Table 2)
Two recent papers have compared supplemental screening with BUS or DBT in women with dense breasts.
The italian trial (ASTOUND TRIAL) showed an incremental cancer detection of 3.1/1000 exams,
favoring ultrasound.
The other paper concluded that either BUS,
DBT or both methods combined increased CDR,
with no significant difference between them
Some issues should be considered when comparing BUS and DBT:
*US is widely available,
has no ionizing radiation,
is a real time imaging,
but has a low VPP,
is operator dependent and time consuming.
* DBT is a single exam (better mammography),
less operator dependent,
a higher PPV but has ionizing radiation.
Our objective was to evaluate which is the best supplemental screening test - US,
DBT or both - in women with non-fatty breasts and negative digital mammography.