RC215-08

Update on Technologist-performed, Screening Breast Ultrasound in Women with Dense Tissue 5 Years after CT Public Act No. 09-41: How Are We Doing Now?

Monday, Nov. 30 10:00AM - 10:10AM Location: Arie Crown Theater



Liane E. Philpotts, MD, New Haven, CT (Presenter) Nothing to Disclose
Madhavi Raghu, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Melissa A. Durand, MD, New Haven, CT (Abstract Co-Author) Research Grant, Hologic, Inc
Laura J. Horvath, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Reni S. Butler, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
Paul H. Levesque, MD, Madison, CT (Abstract Co-Author) Nothing to Disclose
Regina J. Hooley, MD, New Haven, CT (Abstract Co-Author) Nothing to Disclose
PURPOSE

Much experience has been gained during 5 years of performing screening whole breast ultrasound (US) on women with dense tissue. The purpose of this study was to assess current outcomes of these exams and compare to results obtained in our first year.

METHOD AND MATERIALS

A HIPAA-compliant, retrospective review of the breast imaging database (PenRad, MN) was performed to identify all screening ultrasound exams performed at a satellite office of a tertiary academic cancer hospital, during a 5 month period (10/1/14-2/28/15). All screening US exams were performed by dedicated breast technologists using hand-held scanning and with on-site dedicated breast radiologists available. Only cases reported as normal and dense on recent screening mammogram were included. Patients undergoing diagnostic mammography or follow up ultrasounds were not included. The BIRADS final assessment, positive predictive value (PPV3) and cancer detection rate (CRD) was determined and compared to results obtained in our practice in the first year of performing screening ultrasound (10/1/09 - 9/30/10).

RESULTS

756 supplemental screening US were performed during the time period, of which 708 (94%) were reported as normal (BIRADS 1,2). 40 cases (5%) were reported as BIRADS 3. Only eight biopsies were recommended (BIRADS 4,5 1%) of which 2 were malignant (both invasive ductal carcinoma), PPV3=25%. This yield a cancer detection rate of 2.6 per 1000 (2/756). In comparison to our first year results, there has been significant changes with and increase in the rate of BIRADS 1,2 (75% vs 94%, p<0.0001), a decrease in the rate of BIRADS 3 (20% vs 5%, p<0.0001), fewer biopsies recommended BIRADS 4,5 (5% vs 1%, p<0.0001), and an improvement in the PPV3( 6.5% vs 25%, p<0.0001) with maintained CDR (3.2 vs 2.6 per 1000).

CONCLUSION

There has been a large shift in the outcome of supplemental screening ultrasound performed during 5 years with significantly fewer false positives and a higher PPV with maintained CDR, resulting in greatly improved performance of this exam.

CLINICAL RELEVANCE/APPLICATION

With experience, the performance and outcome of supplemental screening ultrasound is greatly improved.