RSNA: Ultrasound, RI Helpful Aids for Dense Breasts

HIAGO — Having an annual RI or ultrasound in addition to mammography is beneficial for women with dense breasts who are at an elevated risk for breast cancer, researchers said here

In a large multicenter trial, these more sensitive technologies increased cancer detection in this group, Wendie A Berg, D, PhD, of Johns Hopkins University, and colleagues reported at the Radiological Society of North America meeting here

“Our recommendation is that women continue their annual mammography, and if they’re high risk, they should have an additional RI,” Berg said “If they can’t tolerate an RI, ultrasound is a reasonable alternative”

The findings come from an analysis of data from the ARIN 6666 study, which involved 2,309 women at 21 centers in the US, anada, and Argentina

All of them had dense breasts and an elevated risk of breast cancer, and underwent a mammography and an ultrasound every year for three years

In the third year, 612 women also had an RI 1,215 were offered one, but many refused, most commonly citing claustrophobia or time constraints

The researchers found that adding ultrasound to mammography increased cancer detection by an absolute rate of 29% — rising from 53% with mammography alone to 82% with both screenings

On ultrasound, 94% of the suspected lesions were found to be cancerous, and 96% of those were node-negative tumors with a median size of 10 mm

Overall, there was a 34% absolute increase in invasive cancer detection, Berg said

She said that adding the technology led to a 5% absolute increase in biopsies compared with mammography alone — but she noted that only 10% of biopsies prompted by ultrasound ended up being malignant

For patients who had an RI in addition to a mammography and an ultrasound, the absolute increase in cancer detection was 56%, Berg said

A total of 89% of cancers identified by RI were invasive, leading to a 67% absolute increase in invasive cancer detection RI did, however, lead to an absolute 77% increase in biopsies

She added that another downside to RI was that it led to a higher rate of short-interval follow-up

“If we choose to have supplemental screening with RI, we need to recognize the high risk of false positives,” Berg said

She urged women at high risk to ask their physicians what their breast density is, and subsequently discuss their risk factors and screening methods with them

“The study nicely showed a real advantage with ultrasound,” said Joseph Tashjian, D, of St Paul Radiology in St Paul, inn “It’s not invasive, it’s easy, it’s not expensive, and it can be done in any setting”

“RI had even better results, but it’s more expensive and it includes administration of a contrast agent,” he said He added that insurance companies are less likely to cover RI because of the cost and the previous lack of data on its efficacy

“[Reimbursement for RI] has always been a problem,” he said, “but it has increased rather than gone away very time new guidelines come out, it’s a reason for insurance companies to revisit their policies”

The ARIN 6666 study was funded by the Avon Foundation and the National ancer Institute

Berg reported being a consultant for Naviscan

A co-author reported relationships with General lectric, Konica inolta Group, VuOP, Real Imaging, and Sectra AB

source : www.medpagetoday.com

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