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Ultrasound as the Primary Screening Test for Breast Cancer: Analysis From ACRIN 6666.

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  • 1Magee-Womens Hospital of UPMC (WAB) and Department of Biostatistics (AIB), University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL (EBM); CERIM, Buenos Aires, Argentina (DL); Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (RAJ); Department of Radiology, Medical University of South Carolina, Charleston, SC (EDP). wendieberg@gmail.com.

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Breast cancer screening using ultrasound (US) shows comparable cancer detection rates to mammography. Ultrasound identified more invasive, node-negative cancers but had higher false positive rates.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Mammography availability is limited globally, coinciding with rising breast cancer incidence.
  • Investigated ultrasound (US) as an alternative screening tool for breast cancer.

Purpose of the Study:

  • To compare the performance characteristics of ultrasound (US) versus mammography for breast cancer screening.
  • Evaluate cancer detection, recall, and positive predictive values of US compared to mammography.

Main Methods:

  • A multi-center study involving 2,809 participants across the US, Canada, and Argentina.
  • Participants underwent three annual screening examinations using US and either film-screen or digital mammography.
  • Cancer detection, recall rates, and positive predictive values were analyzed following biopsy or 12-month follow-up.

Main Results:

  • Cancer detection rates were comparable: 52.3% for US versus 53.2% for mammography (P = .90).
  • US detected a higher proportion of invasive (91.4% vs. 69.5%) and node-negative (64.2% vs. 43.9%) cancers.
  • US exhibited higher recall (10.7% vs. 9.4%) and biopsy rates (5.5% vs. 2.0%), with a lower positive predictive value of biopsy (11.7% vs. 38.1%).

Conclusions:

  • Ultrasound demonstrates comparable cancer detection to mammography in breast cancer screening.
  • US identifies a greater proportion of invasive and node-negative cancers.
  • Increased false positive results are associated with ultrasound screening compared to mammography.