Breast ultrasound in breast cancer surveillance; incremental cancers found at what cost?. (December 2020)

• Record Type: Journal Article
• Authors: Bromley, Luke; Xu, Jennifer; Loh, Su-Wen; Chew, Grace; Lau, Eddie; Yeo, Belinda
• Is Part Of: Breast. Volume 54(2020)
• Page Start: 272
• Page End: 277
• Publication Date: 2020-12
• Subjects: Breast cancer -- Breast ultrasound -- Surveillance -- Biopsy rate -- Diagnostic accuracy -- Recurrence; ASCO American Society of Clinical Oncology -- AUD Australian Dollar -- BIRADS Breast Imaging- Reporting and Data System -- DBT Digital Breast Tomosynthesis -- EBC Early Breast Cancer -- ESMO European Society for Medical Oncology -- FNA Fine Needle Aspiration -- ICDR Incidental Cancer Detection Ratio -- LABC Locally Advanced Breast Cancer -- MMG Mammogram -- MRI Magnetic Resonance Imaging -- NCCN National Comprehensive Cancer Network -- NHMRC National Health and Medical Research Medical Council -- NICE National Institute of Clinical Excellence -- NPV Negative Predictive Value -- PPV Positive Predictive Value -- RANZCR Royal Australian and New Zealand College of Radiologists -- UK United Kingdom -- US Ultrasound -- USA United States of America; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2020.11.007
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Purpose: To determine the diagnostic parameters of breast ultrasound (US) in the setting of routine radiological surveillance after a diagnosis of breast cancer and evaluate costs of the inclusion of breast US as well as any survival benefit of US detected cases of recurrence in surveillance. Methods: 622 patients underwent breast cancer surgery and follow up at Austin Health from July 2009 to December 2015. Retrospective data analysis was performed to determine; diagnostic parameters, financial costs of US and survival outcomes of US detected cases of recurrence. Results: Patients underwent 1–9 years of breast cancer surveillance, with a median of 4.24 years. 390 (62.7%) patients underwent additional breast US surveillance to mammography. 232 (38.3%) fit criteria for use of additional breast US. 199 abnormal imaging episodes occurred, leading to 16 screen detected-cases of locoregional recurrence. US alone generated 107 abnormal images and found 9 cancers. US had a sensitivity of 44.1%, specificity of 95.2% and positive predictive value of 11.7% in comparison to mammography; 20.6%, 97.4% and 9.9% respectively. US had a biopsy rate of 4.0% and lead to an incremental cancer detection rate of 0.38%. The cost of incremental cancer found was $31, 463.72 AUD. Survival outcomes based on method of detection of recurrence were insignificant (p value = 0.71). Conclusions: Breast US has a sensitivity of 44.1% and detected seven recurrences that were mammographically occult. Breast US has a similar PPV to mammography in surveillance. Breast US generated considerable biopsy rates and costs. Survival analysis was not able to detect any benefit of US detected cases of recurrence. Highlights: Breast ultrasound in asymptomatic surveillance after breast cancer surgery was found to have a sensitivity of 44.1%. Breast ultrasound detected 7 recurrences in 390 patients who did not meet criteria for adjunct breast US and had normal mammography Breast ultrasound generated 26 additional biopsies per 1000 US compared to mammography in surveillance, creating considerablecosts. Cancer detection by breast US alone did not lead to statistically significant survival benefit over mammography.