Radiologist-performed hand-held ultrasound screening at average risk of breast cancer: results from a single health screening center

Background: Ultrasound (US) screening is not currently recommended as a routine screening modality in the general population of average risk. The cancer detection yield and positive predictive value in an average risk general population who undergo breast screening by experienced radiologists is unclear. Purpose: To determine the performance of screening breast US in women at an average risk for breast cancer undergoing breast screening by experienced radiologists. Material and Methods: This study received institutional review board approval, and informed consent was waived. A retrospective review of our database revealed 1526 women who underwent prevalence screening US at a single health screening center and had negative findings on digital mammography (MG). The Breast Imaging and Reporting Data System (BI-RADS) final assessments of the breast US were analyzed retrospectively, with the reference standard defined as a combination of pathology and a 12-month follow-up. The cancer detection rate and positive predictive value (PPV2) of the biopsies were calculated according to breast density. Results: The average time to perform a screening US examination was 15-20 min. Of 1526 women, 1095 (71.8%) were classified as BI-RADS category 1 or 2; 340 (22.3%) were classified as category 3; and 91 (6.0%) were classified as category 4. Five malignant lesions were found in women with dense breasts. The overall cancer detection rate was 3.3, and the cancer detection rate for dense breasts was 5.1 per 1000 screens (4.1 per 1000 screens [heterogeneously dense breast], 7.7 per 1000 screens [extremely dense breast]). The PPV2 for biopsies was 5.3%. Conclusion: The radiologist-performed screening US offered to women with an average risk and dense breasts can detect additional mammographically occult breast cancers. In screening US, a relatively high rate of BI-RADS category 3 and 4 lesions was observed.