The Use of Ultrasound in Breast Cancer Screening of Asymptomatic Women with Dense Breast Tissue: A Narrative Review

Abstract

Introduction: Mammography is the standard screening modality for breast cancer; however, sensitivity reduces with increasing breast density, resulting in the potential for masking of cancer. Ultrasound is a potential supplemental screening tool, but its routine use is controversial. Methods: A database search was performed with keywords ''ultrasound'' and ''breast density and screening'', including variations. Articles were included if they assessed the use of hand-held ultrasound as a supplemental screening modality in women with dense breasts. Discussion: Twelve articles were identified. No high-level evidence articles were identified. Cancer detection rates increased with the addition of ultrasound-to-mammography screening protocols. However, this was associated with increased costs per cancer detected, an increased biopsy rate, and a low positive predictive value. The survival benefit, cost versus benefit, and psychological impact of the addition of ultrasound is unknown. Conclusions: The addition of ultrasound to a screening program in an asymptomatic population of women with dense breast tissue detects additional cancers compared with mammography alone. Knowledge regarding a survival or cost benefit associated with increased cancer detection, and the psychological impact of the addition of ultrasound is unknown. Further research is needed to assess whether the addition of ultrasound is cost-effective with respect to clinical outcome and survival.

An Overview of Microwave Imaging for Breast Tumor Detection

“…This results in unnecessary biopsies and interventions and also has an adverse psychological impact on patients. Additionally, US is highly operator dependent, and it hardly shows any micro-calcification which is an important sign of breast cancer [6]. The other prevalent imaging modality is Magnetic Resonance Imaging (MRI) which cannot be used for regular screening as it is expensive, time consuming (20-90 minutes), and claustrophobic.…”

Real‐time automated segmentation of breast lesions using CNN‐based deep learning paradigm: Investigation on mammogram and ultrasound

“…Other than screening, the US finds its wide application in daily practice to improve detection of the lesion and its characterization. 37 It has been reported to diagnose cancer at an earlier stage as compared to MG. 38 Earlier, the US was mainly used for the diagnosis of cysts. But, nowadays with further improved technology, it is more useful in examining the dense breast tissue in comparison to MG. 38 Also, automated breast US (ABUS) is a useful technique that can potentially assist in the preoperative evaluation of breast cancer, such as in the case of ductal carcinoma in situ (DCIS).…”

“…37 It has been reported to diagnose cancer at an earlier stage as compared to MG. 38 Earlier, the US was mainly used for the diagnosis of cysts. But, nowadays with further improved technology, it is more useful in examining the dense breast tissue in comparison to MG. 38 Also, automated breast US (ABUS) is a useful technique that can potentially assist in the preoperative evaluation of breast cancer, such as in the case of ductal carcinoma in situ (DCIS). 39 Breast US is a less expensive, readily available modality, and it does not use ionizing radiation, and it can be used for interventional procedures.…”

“…A positive correlation value is obtained using paired t-test in the case of US-based CAS system. The reason for the better performance of proposed technique in US modality is that it is more sensitive to detect lesions in dense breasts in comparison to MG, and also there is no tissue overlapping in the US unlike MG. 38 This article has a few limitations and gaps leading to open challenges for future work. Firstly, the size of image data used for testing is small.…”

Critical imaging analysis of suspicious non-palpable breast lesions

“…may also increase false-positive diagnosis, added to a screening program it may improve cancer detection rates in patients with non-plapable lesions and dense breast tissue. In addition to its use in the identification of non-palpable lesions, US is also fundamental for locating suspicious preoperative lesions, allowing the localization and removal of these lesions with a higher safety margin and lower number of complications 11,12 .…”