Breast ultrasound in breast cancer surveillance; incremental cancers found at what cost?

Bromley, L.; Xu, Jennifer; Loh, Su-Wen; Chew, Grace; Lau, Eddie; Yeo, Belinda

doi:10.1016/j.breast.2020.11.007

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…The comparable pooled cancer detection rates between mammography and ultrasonography in our analyses, which argue against the clinical value of ultrasonography in this setting, support the results of current studies showing that the addition of ultrasonography to mammography as a surveillance strategy seems to be associated with higher biopsy rates and costs, 36 without influencing the sensitivity or the interval cancer rates. 37 The pooled cancer detection rates among all imaging modalities in our analyses were lower than the current Breast Imaging Reporting and Data System (BI-RADS) benchmarks of 4.7 per 1000 examinations for mammography in the general population, 3.7 per 1000 examinations for ultrasonography in the general population, and 20 per 1000 examinations for breast MRI among women with a hereditary predisposition for breast cancer, 38 further supporting the notion that the performance of imaging modalities in this setting does not meet clinical performance expectations.…”

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

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Yield of Surveillance Imaging After Mastectomy With or Without Reconstruction for Patients With Prior Breast Cancer

et al. 2022

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ImportanceA discrepancy on current guidelines and clinical practice exists regarding routine imaging surveillance after mastectomy, mainly regarding the lack of adequate evidence for imaging in this setting.ObjectiveTo investigate the usefulness of imaging surveillance in terms of cancer detection and interval cancer rates after mastectomy with or without reconstruction for patients with prior breast cancer.Data SourcesA comprehensive literature search was conducted in 3 electronic databases—PubMed, ISI Web of Science, and Scopus—without year restriction. References from relevant reviews and eligible studies were also manually searched.Study SelectionEligible studies were defined as those conducting surveillance imaging (mammography, ultrasonography, or magnetic resonance imaging [MRI]) of patients with prior breast cancer after mastectomy with or without reconstruction that presented adequate data to calculate cancer detection rates for each surveillance method.Data Extraction and SynthesisIndependent data extraction by 2 investigators with consensus on discrepant results was performed. A quality assessment of studies was performed using the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies–2) template. The generalized linear mixed model framework with both fixed-effects and random-effects models was used to meta-analyze the proportion of cases across studies including 3 variables: surveillance method, reconstruction after mastectomy, and surveillance measure.Main Outcomes and MeasuresThree outcome measures were calculated for each eligible study and each surveillance imaging method within studies: overall cancer detection (defined as ipsilateral cancer, both palpable and nonpalpable) rate per 1000 examinations, clinically occult (nonpalpable) cancer detection rate per 1000 examinations, and interval cancer rate per 1000 examinations.ResultsIn total, 16 studies were eligible for the meta-analysis. The pooled overall cancer detection rates per 1000 examinations were 1.86 (95% CI, 1.05-3.30) for mammography, 2.66 (95% CI, 1.48-4.76) for ultrasonography, and 5.17 (95% CI, 1.49-17.75) for MRI. For mastectomy without reconstruction, the rate of clinically occult (nonpalpable) cancer per 1000 examinations (2.96; 95% CI, 1.38-6.32) and the interval cancer rate per 1000 examinations (3.73; 95% CI, 0.84-3.98) were lower than the overall cancer detection rate (including both palpable and nonpalpable lesions) per 1000 examinations (6.41; 95% CI, 3.09-13.25) across all imaging modalities. The interval cancer rate per 1000 examinations for mastectomy with reconstruction (3.73; 95% CI, 0.41-2.73) was comparable to the pooled cancer detection rate per 1000 examinations (4.73; 95% CI, 2.32-9.63) across all imaging modalities. In all clinical scenarios and imaging modalities, lower rates of clinically occult cancer compared with cancer detection rates were observed.Conclusions and RelevanceLower detection rates of clinically occult—compared with overall—cancer across all 3 imaging modalities challenge the use of imaging surveillance after mastectomy, with or without reconstruction. Findings suggest that imaging surveillance in this context is unnecessary in clinical practice, at least until further studies demonstrate otherwise. Future studies should consider using the clinically occult cancer detection rate as a more clinically relevant measure in this setting.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Yield of Surveillance Imaging After Mastectomy With or Without Reconstruction for Patients With Prior Breast Cancer

et al. 2022

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“…Numerous studies have underscored the efficiency of conventional imaging techniques for breast cancer diagnosis, including magnetic resonance imaging (MRI), ultrasound (US), and computed tomography (CT) [ 19 , 20 , 21 ]. Nevertheless, integrating these imaging modalities into operating rooms faces great challenges, and notably, they lack the capability to offer real-time feedback to surgeons reliably [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

The Down-Shifting Luminescence of Rare-Earth Nanoparticles for Multimodal Imaging and Photothermal Therapy of Breast Cancer

Gao,

et al. 2024

Biology

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Nanotheranostic agents capable of simultaneously enabling real-time tracking and precise treatment at tumor sites play an increasingly pivotal role in the field of medicine. In this article, we report a novel near-infrared-II window (NIR-II) emitting downconversion rare-earth nanoparticles (RENPs) to improve image-guided therapy for breast cancer. The developed α-NaErF4@NaYF4 nanoparticles (α-Er NPs) have a diameter of approximately 24.1 nm and exhibit superior biocompatibility and negligible toxicity. RENPs exhibit superior imaging quality and photothermal conversion efficiency in the NIR-II range compared to clinically approved indocyanine green (ICG). Under 808 nm laser irradiation, the α-Er NPs achieve significant tumor imaging performance and photothermal effects in vivo in a mouse model of breast cancer. Simultaneously, it combines X-ray computed tomography (CT) and ultrasound (US) tri-modal imaging to guide therapy for cancer. The integration of NIR-II imaging technology and RENPs establishes a promising foundation for future medical applications.

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“…However, the sensitivity of supplemental US is likely lower for women with PHBC [11]. Adjunctive screening US has low speci city, with many additional benign lesions being identi ed and investigated, of detriment to both the patient via heightened anxiety and to the health system via increased costs [9,10,[12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Contrast Enhanced Mammography In Breast Cancer Surveillance

Elder¹,

Matheson²,

Nickson³

et al. 2023

The Breast

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Breast ultrasound in breast cancer surveillance; incremental cancers found at what cost?

Cited by 9 publications

References 21 publications

Yield of Surveillance Imaging After Mastectomy With or Without Reconstruction for Patients With Prior Breast Cancer

Yield of Surveillance Imaging After Mastectomy With or Without Reconstruction for Patients With Prior Breast Cancer

The Down-Shifting Luminescence of Rare-Earth Nanoparticles for Multimodal Imaging and Photothermal Therapy of Breast Cancer

Contrast Enhanced Mammography In Breast Cancer Surveillance

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