NEW YORK--There is a role for
ultrasound in breast cancer screening and
diagnosis, but many physicians do not
seem to know what it is, according to
Annette Brown, MD, a radiologist in the
Mammography Division of Long Island
College Hospital in Brooklyn. At the
"Breast Cancer in Women of Color"
meeting, Dr. Brown expressed her frustration
or "gripes" as she put it.
She called ultrasound the first line of
defense for women under 40 who have a
mass, in order to spare them exams involving
radiation. "My gripe with any
physician who is here," she said, "is when
you send a patient for a sonogram, you
can't just say 'bilateral ultrasound' or 'ultrasound
right breast' and leave it at that.
You have to say what you are looking for.
Is there a mass in the breast? Where is it?
Other than that, we're on a fishing expedition,
and we may or may not find it."
Dr. Brown told ONI that she gets requests
for bilateral ultrasounds every day.
"You have to waste your time calling
them. 'Excuse me, doctor, where is it?'
Otherwise you are roaming around seeing
what you bump into. If you cannot
say for sure that a mass is a simple cyst,
then you have to do something about it
and not say you didn't see it."
There are patients for whom such a
"fishing expedition" makes sense, she
said, eg, a young patient with dense
breasts and a strong family history of
breast cancer. "Because she has dense
breasts, you are probably not going to see
anything on the mammogram. She deserves
a second look with anything you
have. I think in a patient like that, you
have to go roaming around the breast
and make sure there is nothing there.
The problem, of course, is that such aggressive
screening can lead to more unnecessary
Women with dense breasts who have
had breast cancer also deserve screening
sonograms; even those without dense
breasts deserve that second look, she said.
'Of course, I explain the drawbacks to
the patient and the fact that we may not
always find an existing mass."
Although Dr. Brown feels ultrasound
is not ready for prime time as a breast
screening tool in the general population,
still "it's a wonderful exam," she said. "It
gives us a lot of information and can
distinguish between a cyst and a solid
mass. However, since it is done with a
hand-held transducer, if the technologist
doesn't put the transducer where the
problem is, we're not going to have a
picture of it."
She further noted that ultrasound will
not find very small lesions in the breast
or show lesions that have the same cystic
properties as the surrounding tissues of
the breast. "The other problem is fatty
breasts. I sometimes get a request for an
ultrasound, and find that the woman has
fatty breasts. Ultrasound doesn't like fat,"
Dr. Brown said.