Targeted Breast Ultrasound Can Reduce Biopsies for Women under Forty

Targeted breast ultrasound of suspicious areas of the breast, including lumps, is a safe, reliable and cost-effective alternative to invasive biopsies for women under age 40, according to the findings of two studies presented at the 95th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).

"By performing high-quality breast ultrasound, we can reduce the number of expensive and avoidable invasive diagnostic procedures in young women," said senior author Constance D. Lehman, M.D., Ph.D., professor and vice chair of radiology at the University of Washington and director of imaging at the Seattle Cancer Care Alliance. "We don’t want to be overly aggressive with this population."

The researchers conducted two studies in which targeted ultrasound was used to distinguish between potentially cancerous masses and benign findings in young women who had detected breast lumps or other focal (specific) areas of concern in their breasts. The first study included 1,123 ultrasound examinations of women under age 30, while the second included 1,577 ultrasound examinations of women ages 30 to 39.

Across both studies, all instances of cancer at the site of the clinical concern were positively identified through targeted ultrasound. In addition, all negative ultrasound findings correctly identified benign changes in the breast. The only malignant mass not identified by ultrasound was an unsuspected lesion outside of the targeted examination area. That cancer was identified by a full breast mammogram.

The incidence of malignancy among women in their 30s was 2%. The incidence of malignancy among women younger than 30 was 0.4 percent.

Fig 1. A breast ultrasound image showing a benign mass.

"Surgical excision or needle biopsy of tissue can be painful, expensive and frequently unnecessary in these age groups, which have very low rates of malignancies," Dr. Lehman said. "In most cases, monitoring with targeted ultrasound is a very safe alternative."

She added that ultrasound should be the diagnostic tool of choice for young women seeking care for breast lumps and other suspicious focal signs and symptoms. "It is time we used ultrasound to reduce unnecessary morbidity and costs associated with more aggressive invasive approaches," Dr. Lehman said.

Also see Abstracts:
- Outcomes of Targeted Ultrasound Evaluation in Women Under 30 Years of Age with Focal Breast Signs or Symptoms. Presented by Dr. Vilert Loving, MD
- Contribution of Mammography to Ultrasound Evaluation of Women 30 to 39 Years of Age with Focal Breast Signs or Symptoms . Presented by Michael Portillo, MD

For more information:
- Onco'Zine - The International Cancer Network

Cryoablation of Early Invasive Ductal Breast Cancer With MRI Confirmation Shows Promising Clinical Benefits

Early clinical experience using a Visica® Treatment System to ablate malignant tumors and a margin of surrounding tissue, confirm the effectiveness of ultrasound guided cryoablation, a minimally invasive non-surgical procedure that uses extreme cold to destroy tumors, to completely eradicate small, unifocal Invasive Ductal Breast Cancer (IDC).

Initial data from this multi-center study confirming the data was presented today during the 94th Scientific Assembly and Annual Meeting (November 30 – December 5, 2008) of the Radiological Society of North America (RSNA).

"We are very encouraged that our preliminary results demonstrate that in selected early IDC breast cancers, cryoablation with MRI confirmation may offer the same therapeutic benefit as lumpectomy with less morbidity, improved cosmesis and less cost,” said Garry Levine, M.D. Director of Breast Imaging at Hoag Breast Care Center in Newport Beach, CA.

The study was designed to evaluate the ability of breast contrast-enhanced MRI (CEMRI) to assess the effectiveness of ultrasound guided cryoablation for the local treatment of small, unifocal IDC. Patients with newly diagnosed IDC underwent an ‘early’ pre-ablation CEMRI to establish its MR enhancement pattern. Ultrasound-guided cryoablation was then performed using a Visica Treatment System, developed by Sanarus Medical (Pleasanton, CA), to ablate the malignant tumor and a margin of surrounding tissue.

A 'delayed' CEMRI was performed approximately four weeks post-ablation followed by a standard surgical lumpectomy. The early and delayed CEMRI findings were correlated with the surgical histopathology. In all 15 cases, the post-ablation MRI's showed no suspicious contrast enhancement remaining at the targeted tumor site and histopathology confirmed complete tumor kill within the intended ablation zone. In three cases histopathology confirmed residual DCIS and/or small satellite lesions outside the cryoablation zone.

"Lack of residual suspicious enhancement on post-cryoablation CEMRI appears to correlate with complete tumor kill within the targeted ablation zone. We believe the novel MR findings termed 'black hole', which correlates with an area of coagulation necrosis at the cryoablation site and a surrounding uniform thin rim enhancement, and 'cryohalo' which corresponds to a zone of inflammation at the cryoablation margin, serve as markers for successful ablation, giving us a noninvasive and reproducible method to verify clinical results," explained Dr. Levine.

The study conducted by Dr. Levine and Steven Poplack, MD, Co-Director of Breast Imaging at Dartmouth Hitchcock Medical Center is similar to the National Cancer Institute (NCI) funded clinical trial recently initiated by the American College of Surgeons Oncology Group (ACOSOG).
The ACOSOG study, (A Phase II Trial Exploring the Success of Cryoablation Therapy in the Treatment of Invasive Breast Carcinoma), will also evaluate cryoablation as well as the ability of MRI to evaluate post-cryoablation efficacy.

Click here to read the abstract (New Findings on Contrast-enhanced Magnetic Resonance Imaging (CEMRI), the 'Black Hole' and 'Cryohalo' are Markers for the Efficacy of Ultrasound (US)-guided Cryoablation of Small (less than or equal to 15mm) Unifocal Invasive Ductal Breast Cancer).

Also see:

• Warren RM, Bobrow LG, Earl HM, Can breast MRI help in the management of women with breast cancer treated by neoadjuvant chemotherapy? British Journal of Cancer (2004) 90, 1349–1360
• Sotome K, Yamamoto Y, Hirano A, The role of contrast enhanced MRI in the diagnosis of non-mass image-forming lesions on breast ultrasonography. Breast Cancer 2007;14(4):371-80.