Is Whole Breast Ultrasound (WBUS) Preferable to Target Scanning in Symptomatic Breast Disease?: BMUS Pump Priming Research Grant 2002: Final report

Abstract

Aim to estimate the potential clinical utility of ipsilateral whole breast ultrasound (WBUS) in women attending a symptomatic clinic with focal abnormality. Method Between February 2003 and January 2004 all women attending the rapid access symptomatic breast clinic at a large UK DGH with signs and symptoms of focal breast abnormality were invited to participate in a prospective cohort study to evaluate the role of ipsilateral WBUS in identifying synchronous abnormality elsewhere in the breast. Ultrasound examinations were performed and reported by one of three qualified and experienced non-medical sonographers. Diagnostic outcomes were corroborated by tissue diagnosis or follow-up of no less than 12 months duration. Results Six-hundred-and-eleven women were recruited to the study. Six-hundred-and-seventy-two breasts were scanned. Mean duration of follow-up was 26 9 months (range 21–30 months). Overall prevalence of malignancy in the sample of women was 6 4%; sensitivity and specificity of WBUS were 89 7% and 97 8%, respectively. Index lesion pathology was present in 238 (35 4%) breasts. Incidental abnormality was identified elsewhere in the breast in 153 (22 8%) breasts. Of the synchronous lesions identified, 14 (9 2%) were malignant. Twelve (85 7%) of a total of 15 malignancies present elsewhere in the breast occurred in women with a malignant presenting abnormality. Two malignancies (one index, one incidental) were not detected at the WBUS examination. There was no statistically significant difference in interval rescan rate (21 7%) or malignancy positive predictive rate for biopsy (43%) between index and incidental lesions. Conclusion WBUS will reveal synchronous incidental abnormality in approximately one in five women referred to a ‘one-stop’ clinic with a focal lump, localized pain or focal area of nodularity. These additional abnormalities generate diagnostic follow up and/or interventional examinations in the same manner as presenting abnormalities. The majority of incidental abnormalities are benign, incidental malignancy being associated with increased patient age, presenting palpable lump and index malignancy. The case for performing WBUS in symptomatic women with no, or benign index abnormality is unsubstantiated.