Ultrasound can replace mammography for breast lumps

Ultrasound is a reliable first step in elucidating local breast problems such as nodules or pain. A large-scale Dutch study, coordinated by Radboudumc, shows that a breast radiologist can almost certainly rule out breast cancer using ultrasound. Radiologist Linda Appelman: “An important additional advantage is that we can immediately reassure four out of five women that they do not have breast cancer.”

In the Netherlands, 70,000 women are admitted to hospital every year because of a lump or swelling in the breast. The first exam they get is a mammogram or X-ray of the breast. Women often find this exam stressful because the breasts are pressed together. This mammogram rarely leads to clarification of complaints, which is why an ultrasound is almost always made at the location of the complaints to make the diagnosis.

Why don’t we do an ultrasound first and then an X-ray if necessary? Breast radiologists Linda Appelman and Ritse Mann of the Radboud University Medical Center are planning a large-scale study to find out. In 2,000 women with local breast problems, they reversed the image sequence: first ultrasound, then mammography. At Radboudumc in Nijmegen, Noordwest Hospital in Alkmaar and St. Antonius, only specialized chest radiologists performed these ultrasound examinations.

Echo is not painful and very reliable

The research shows that ultrasound is very reliable: the procedure can rule out breast cancer with 99.8 percent certainty. Four out of five women were already able to calm down during the ultrasound. They only had a benign abnormality such as a cyst. In every fifth woman, the ultrasound was still inconclusive. They were followed and eventually half of them turned out to have a form of breast cancer.

Appelman sees the great advantages of ultrasound for the patient: “A woman has direct contact with the radiologist and lab technician. Can explain and show the complaint better. With the images, the radiologist can immediately determine the cause of the complaint.” If the images on the ultrasound are not abnormal, the woman can immediately relax. Ultrasound is also not painful and X-rays are not used.”

Tool for suspected breast cancer

The question is whether ultrasound will replace mammography in the future. “I think that the nature of the condition, the ultrasounds, the age and whether you can participate in the population screening are all important factors when choosing a mammogram. In most cases this will not be necessary,” says Appelman. “Certainly for breast cancer screening and if a doctor wants to fully examine both breasts when breast cancer is suspected, mammography has added value.”

A disadvantage of ultrasound is that the chest radiologist only examines the problematic part of the thorax. Completely examining both breasts with ultrasound is a very laborious task. In 0.4 percent of the women in the study, mammograms showed breast cancer (precursor) elsewhere than where the complaint was made. Appelman: “So these were incidental findings that usually occur during breast cancer screening or if complaints arise.”

The research team has created a flowchart showing when follow-up visits after the ultrasound are needed. This tool takes into account age, participation in population screening, complaints, clinical picture and clarity of ultrasound. “If in doubt, do some research,” Appelman advises. “It could be a mammogram, but a biopsy will probably bring more clarity.” The feasibility of the flowchart and the effect of actually scrapping mammography will be further investigated.

  • Author: editors
  • Source: Health Net