NEW ORLEANSHigh-resolution ultrasound provides additional
information about mammographically identified malignant
calcifications and may find malignancies unseen on mammography,
Beverly E. Hashimoto, MD, said at the annual meeting of the American
Roentgen Ray Society.
Dr. Hashimoto and her colleagues at Virginia Mason Medical
Center, Seattle, prospectively studied 220 women with abnormal
mammograms. The investigators performed high-resolution breast
ultrasound and interpreted the scans without access to any other
clinical information. Masses were classified as malignant or benign,
and microcalcification clusters were identified.
Of the 220 women, 86 had clustered calcifications on mammography
without an associated mass, and 24 of these had histologically
confirmed malignancy. High-resolution ultrasound detected
calcifications in 20 (83%) of the 24 women with mammographically
detected calcifications. But more importantly, high-resolution
ultrasound revealed malignancy in 12 (60%) of these 20 women, and on
biopsy, all of the lesions were found to be malignant.
High-resolution ultrasound was not as accurate at detecting
nonmalignant calcifications: Of the 86 women with mammographic
calcifications, ultrasound detected calcifications in only 58 (67%).
In an interview with Oncology News International, Dr. Hashimoto said,
Even though ultrasound is operator dependent, this technique is
capable of detecting calcifications at a level much higher than
previously possible. We were able to detect calcifications in two
thirds of the women with mammographically identified calcifications,
compared with a 5% detection rate with routine ultrasound.
Dr. Hashimoto went on to say that, in the continuing effort to reduce
the number of unnecessary biopsies, high-resolution ultrasound can
play an especially important role, since the technique detected
abnormal tissue in 60% of the women with no evidence of disease other
than calcifications on mammography.
Dr. Hashimoto and her colleagues concluded that high-resolution
ultrasound can detect calcifications in the majority of cases, but it
is much better at identifying malignant calcifications than benign
calcifications. Furthermore, when calcifications are detected
mammograph-ically, high-resolution ultrasound may provide information
useful for diagnostically risk-stratifying patients; that is, women
with calcifications on both mammography and ultrasound have a much
higher risk of having breast cancer.
Even though our work must be considered preliminary, Dr.
Hashimoto said, here at Virginia Mason we are now using this
technique in cases where we normally wouldnt have considered
using ultrasound a few years ago.