Adding Ultrasound or Tomosynthesis to Screening Mammography for Dense Breast Tissue

May 13, 2016

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Take-Home Message:

For women with dense breast tissue getting screening mammograms, supplemental imaging with ultrasound may detect more breast cancers than tomosynthesis.

 

Summary

Adjunct Screening with Tomosynthesis or Ultrasound in Women with Mammography-Negative Dense Breasts: Interim Report of a Prospective Comparative Trial

Authors: Tagliafico, A.S. et al.
Source: J Clin Oncol, 10.1200/JCO.2015.63.4147
www.ncbi.nlm.nih.gov/pubmed/26962097

Some women with dense breast tissue have an increased risk of breast cancer. Dense breast tissue can make cancer detection with standard screening mammography difficult. Therefore, women with dense breasts are often offered the option of receiving either ultrasound or tomosynthesis (“3D mammograms”) in addition to their screening mammograms. This is the first study to directly compare the effectiveness of ultrasound and tomosynthesis in breast cancer detection.

The study enrolled 3,231 women with dense breasts who had no suspicious findings on routine screening mammogram. These women then received both ultrasound and tomosynthesis. Of 131 women who had suspicious results on either of these two modalities, 107 ultimately had benign findings. The false positive rate between the two imaging techniques was the same. The remaining 24 women had findings that were found to be cancer: 12 cases were seen with both ultrasound and tomosynthesis, 11 of the cancers were detected only with ultrasound and just 1 cancer case was detected solely by tomosynthesis. The women will continue to be followed for long-term results.

These results suggest that ultrasound may detect more cancer in women with dense breasts whose screening mammograms are negative.  But the investigators emphasize that tomosynthesis did detect many of the breast cancers observed in their study. It should still be considered a very useful tool.  The decision about which modality to choose should include careful consideration of a care center’s resources and goals.