Additional value of supplemental breast ultrasound in women with a personal history of breast cancer undergoing mammography surveillance

Objectivesto evaluate the diagnostic value of supplemental breast ultrasound (SBU) in women with a personal history of breast cancer (PHBC) undergoing mammography surveillance. Materials and MethodsThis retrospective single-center study analyzed the data of women with PHBC and mammography with SBU between 2015 and 2016.Inclusion criteria were: BI-RADS 1-2 with at least 24 months follow-up, BI-RADS 3 with at least 36 months follow-up, and BI-RADS 4-5 with histopathologic confirmation.Performance measures included sensitivity, specificity and incremental cancer detection rate (ICDR) for mammography and SBU, separately. ResultsOf the 1089 examinations in 992 women (mean age 62.9 11.9 years), 75.7% had breastconserving surgery (BCS) and 24.3% mastectomy.SBU did not detect additional cancers in the breast (0.2% in BCS and 1.0% in mastectomy) but identified three additional axillary lymphnode recurrences, (0.2% in BCS and 0.3% in mastectomy).In women with BCS mammography and SBU had sensitivity 75.0%(95%CI: 19.4,99.4) and 100.0%(95%CI: 39.8,100.0),specificity 99.7% (95%CI: 98.1,99.9)and 97.9% (95%CI: 95.7,99.3),respectively.The ICDR for SBU was 3.3 malignancy/1000 examinations.In women with mastectomy, mammography and SBU had sensitivity 75.0%(95%CI: 19.4,99.4) and 100.0%(95%CI: 39.8,100.0),specificity 99.7% (95% CI: 98.1,99.9)and 97.9% (95% CI: 95.7,99.3),respectively.The ICDR for SBU was 3.3 malignancy/1000 examinations.Overall, SBU led to increased rates of additional biopsies and short-term follow-ups. ConclusionCompared with mammography alone, SBU provided added value only for detecting axillary recurrences but not for identifying additional breast cancers.Its use should be balanced against increased rates of biopsy and recall.