March 2015

Wednesday, March 4 (ECR) – Imaging dense breasts or tissue abnormalities is still challenging in breast screening, but breast ultrasound continues to prove its utility, experts will show today in a Refresher Course at the ECR.

It is estimated that mammography sensitivity ranges from 65% to 91%. The masking effect of dense breast tissue is the most relevant cause of false-negatives, according to Dr. Veronica Girardi from the Istituti Ospedalieri Bresciani in Brescia, Italy.

“When we consider breast density, there are two different issues: one is that it’s influencing cancer detection on mammographic imaging and the second is its possible independent effect on breast cancer risk. Breast density is associated with an increased risk of breast cancer at any age, but it does not seem to influence ultrasound accuracy. For this reason, the association of ultrasound to mammography in women with dense breasts has been proposed by many authors, although there is no evidence of mortality reduction,” she said.

Ultrasound is quick, widely available, well tolerated, very safe, and relatively cheap. It can boost cancer detection by about 2.9%, Girardi noted. However, ultrasound may also increase false-positive biopsies, which means it implies a relevant additional cost and causes a major increment of invasive diagnostic procedures. According to previous studies, additional cancer detection by ultrasound is likely to improve screening benefit in dense breasts. Therefore it supports the implementation of a randomised trial of adjunct ultrasound in women with increased breast tissue density, Girardi believes. She recommends ultrasound screening in women at very high risk for breast cancer – women with a lifetime risk of over 20%, who are BRCA positive, or have a family history of pre-menopausal breast cancer, who cannot tolerate breast MR imaging. Women with dense breast tissue and intermediate or average risk should also be screened with ultrasound.

Elastosonography offers potential, according to Dr. Corinne Balleyguier from the diagnostic imaging department at Gustave Roussy Cancer Campus in Villejuif, France, as it improves the specificity of ultrasound. The most common elasticity imaging technique is free-hand elastography, which is heavily dependent on the operator. Shear-wave elasticity imaging provides qualitative and quantitative analysis of a lesion, and is less dependent on the operator, she pointed out.

Shear-wave elasticity or elastography may improve breast lesion characterisation and help better categorise undetermined lesions such as BI-RADS 4a and 3 nodules. Elasticity imaging characteristics have actually been added to the latest version of the BI-RADS ultrasound lexicon.

Dr. Suzanne Diepstraten, from the radiology department at the University Medical Centre Utrecht in the Netherlands, will question the necessity of nodal staging of breast cancer.

Veronica Girardi, Brescia, Italy; Corinne Balleyguier, Villejuif, France

Refresher Course: Breast

Wednesday, March 4, 08:30–10:00, Room F2
RC 102 Breast ultrasound 2015
Moderator: K. Kinkel; Chêne-Bougeries/CH

  • A. Evidence for screening in dense breasts
    V. Girardi; Brescia/IT
  • B. Elastosonography: true advances or false hope?
    C.S. Balleyguier; Villejuif/FR
  • C. Nodal staging of breast cancer: still needed?
    S.C.E. Diepstraten; Utrecht/NL

Caption: A 62-year-old woman with non-palpable 9 mm invasive ductal carcinoma only seen on ultrasound. A radial sonogram obtained at the 5 o’clock position in the left breast shows a hypoechoic irregular mass.
Copyright: © Dr. Veronica Girardi, Istituti Ospedalieri Bresciani in Brescia, Italy