Islamiat O. Ego-Osuala MD, Presenter: Nothing to Disclose

Kristin Elias MD, Abstract Co-Author: Nothing to Disclose

Sara Daniel Shaylor MD, Abstract Co-Author: Nothing to Disclose

Marissa Lauren Albert MD, MSc, Abstract Co-Author: Nothing to Disclose

Hildegard B. Toth MD, Abstract Co-Author: Nothing to Disclose

Linda Moy MD, Abstract Co-Author: Nothing to Disclose

To determine the utilization and role of adjunct ultrasound (US) screening examination with the implementation of the breast density notification law.

IRB approved retrospective review of women who underwent a hand held high resolution whole breast US exam performed by one of 11 experienced breast US technologists from Jan 1, 2013 to March 31, 2014. Screening mammogram and US exams were performed at a large academic center and two satellite private practices and evaluated by 1 of 16 breast imaging radiologists. The findings of the screening mammograms were known by the sonographer before the US exam was performed. Repeat scanning for lesions identified by the technologists was performed by the radiologists. The follow up rate, biopsy rates and added cancer detection rates were determined. 

A total of 42,341 screening mammograms were performed in 36,523 women. Breast density was predominantly fatty in 3980 (9.4%), scattered fibroglandular tissue in 17,106 (40.4%), heterogeneously dense in 17,910 (42.3%) and extremely dense in 3345 (7.9%). Of 3044 women who underwent 3167 screening US exam, 2253 (74%) of women had dense breasts and 1857 (61%) had average risk for breast cancer. Screening US exam was performed within 1 month of the screening mammogram in 80.5% of the cases and 19.0% between 4-6 months from the mammogram. Of 3,167 US exams, 2614/3167 (82.5%) US exams were assessed as BIRADS 1 or 2, 276 (8.7%) as BIRADS 3, 277 (8.7%) as BIRADS 4 or 5. 18 biopsies were cancelled because the lesion was no longer seen or reassessed as benign. Biopsy was performed in 259 lesions, yielding 249 (96.1%) benign results, 5 high-risk lesions and 5 malignancies. Of 249 benign lesions, 109 (43.8%) were complex cyst and 59 (23.7%) were fibrocystic change. Of 10 lesions that underwent surgical excision, 6 were malignancies, 3 IDCs and 3 DCIS, yielding a PPV of 2.32%. 4 of 6 cancers were less than 1cm. 4 of 6 cancers were detected in women with abnormal mammographic finding. Screening US led to an additional cancer yield of 2/ 3167 (0.06%).

Supplemental whole breast US detects mammographically occult cancers, although our rate is much lower than previous studies.  

The low PPV of screening US in our study where most women had dense breast tissue and were average risk suggests further studies are necessary to identify the women who may benefit from the exam.

Ego-Osuala, I, Elias, K, Shaylor, S, Albert, M, Toth, H, Moy, L, Impact of Breast Density Notification Law in the Detection of Breast Cancer: Initial 15 Months Experience.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14012167.html